Provider Demographics
NPI:1235239823
Name:CORBETT, KIMBERLY FARA (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:FARA
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4789 MOUNT ASHMUN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3952
Mailing Address - Country:US
Mailing Address - Phone:619-298-2098
Mailing Address - Fax:619-298-2098
Practice Address - Street 1:4411 30TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4286
Practice Address - Country:US
Practice Address - Phone:619-298-2098
Practice Address - Fax:619-298-2098
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA776634000OtherMAGELLAN PIN
CA352923OtherMHN PROVIDER ID NUMBER
CA0PL216690OtherTRICARE PIN
CA0PL216690OtherBLUE SHIELD OF CA PIN
CA7314642OtherAETNA PIN
CAPSY216690Medicaid