Provider Demographics
NPI:1639373491
Name:MARJORIE COBURN, PH.D.
Entity Type:Organization
Organization Name:MARJORIE COBURN, PH.D.
Other - Org Name:PHOBIA AND ANXIETY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-456-5065
Mailing Address - Street 1:836 PROSPECT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4213
Mailing Address - Country:US
Mailing Address - Phone:858-456-5065
Mailing Address - Fax:
Practice Address - Street 1:836 PROSPECT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4213
Practice Address - Country:US
Practice Address - Phone:858-456-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8758103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8758Medicare ID - Type Unspecified