Provider Demographics
NPI:1629267000
Name:MCDONALD, CARRIE REBECCA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:REBECCA
Last Name:MCDONALD
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE C101
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0841
Practice Address - Country:US
Practice Address - Phone:858-534-2678
Practice Address - Fax:858-534-1078
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20167103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist