Provider Demographics
NPI:1407097959
Name:GROESBECK GOLDFARB, JANICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:GROESBECK GOLDFARB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4909
Mailing Address - Country:US
Mailing Address - Phone:619-294-9535
Mailing Address - Fax:619-295-4113
Practice Address - Street 1:3576 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4909
Practice Address - Country:US
Practice Address - Phone:619-294-9535
Practice Address - Fax:619-295-4113
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical