Provider Demographics
NPI:1619056132
Name:SOMMERFELD, KAREN LYNDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNDA
Last Name:SOMMERFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNDA
Other - Last Name:SOMMERFELD-FORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1088 PONDEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2146
Mailing Address - Country:US
Mailing Address - Phone:760-510-6765
Mailing Address - Fax:
Practice Address - Street 1:225 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4203
Practice Address - Country:US
Practice Address - Phone:760-739-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13048AMedicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST