Provider Demographics
NPI:1568673622
Name:AMARAL, CLARENCE LOUIS II (PH D)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LOUIS
Last Name:AMARAL
Suffix:II
Gender:M
Credentials:PH D
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 1212
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1212
Mailing Address - Country:US
Mailing Address - Phone:619-294-0294
Mailing Address - Fax:858-794-9966
Practice Address - Street 1:851 S 35TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2701
Practice Address - Country:US
Practice Address - Phone:619-294-0294
Practice Address - Fax:858-794-9966
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY157930Medicaid
CAPSY157930Medicaid