Provider Demographics
NPI:1578612388
Name:RABIN, ADELE SHERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:SHERRY
Last Name:RABIN
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 1:10455 POMERADO RD
Mailing Address - Street 2:DALEY HALL, AIU
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1717
Mailing Address - Country:US
Mailing Address - Phone:858-635-4801
Mailing Address - Fax:858-635-4811
Practice Address - Street 1:10455 POMERADO RD
Practice Address - Street 2:DALEY HALL, AIU
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1717
Practice Address - Country:US
Practice Address - Phone:858-635-4801
Practice Address - Fax:858-635-4811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA06J1187OtherCHAMPUS
CAPSY11311Medicaid
CAOPL113110OtherBLUE SHIELD
CAOPL113110OtherBLUE SHIELD