Provider Demographics
NPI:1619412806
Name:WAVES, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:WAVES, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRWOMAN AND PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-403-5578
Mailing Address - Street 1:15525 POMERADO RD
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2435
Mailing Address - Country:US
Mailing Address - Phone:619-403-5578
Mailing Address - Fax:866-273-9073
Practice Address - Street 1:15525 POMERADO RD
Practice Address - Street 2:SUITE C-5
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2435
Practice Address - Country:US
Practice Address - Phone:619-403-5578
Practice Address - Fax:866-273-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty