Provider Demographics
NPI:1255668455
Name:CASPER, SHERRY G (PSY D /PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:G
Last Name:CASPER
Suffix:
Gender:F
Credentials:PSY D /PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421146
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142
Mailing Address - Country:US
Mailing Address - Phone:619-807-7410
Mailing Address - Fax:877-485-5961
Practice Address - Street 1:9606 TIERRA GRANDE #201
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:619-485-5961
Practice Address - Fax:877-485-5961
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20550103K00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst