Provider Demographics
NPI:1407482623
Name:CENCIRULO, JASON (PSYD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CENCIRULO
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 1:317 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1630
Mailing Address - Country:US
Mailing Address - Phone:619-320-4601
Mailing Address - Fax:888-412-0444
Practice Address - Street 1:317 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1630
Practice Address - Country:US
Practice Address - Phone:619-320-4601
Practice Address - Fax:888-412-0444
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical