Provider Demographics
NPI:1346236445
Name:KAUPP, MARK ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:KAUPP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5452 REDDING RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1133
Mailing Address - Country:US
Mailing Address - Phone:619-665-5590
Mailing Address - Fax:619-297-4496
Practice Address - Street 1:2835 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 120-C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3825
Practice Address - Country:US
Practice Address - Phone:619-665-5590
Practice Address - Fax:619-297-4496
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist