Provider Demographics
NPI:1407804818
Name:BARILE, CRYSTAL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN
Last Name:BARILE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ZUMA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2444
Mailing Address - Country:US
Mailing Address - Phone:949-683-1008
Mailing Address - Fax:714-389-1091
Practice Address - Street 1:17341 IRVINE BLVD
Practice Address - Street 2:208
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3010
Practice Address - Country:US
Practice Address - Phone:949-683-1008
Practice Address - Fax:714-389-1091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist