Provider Demographics
NPI:1679683007
Name:SCHANOWITZ, JEFF (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:SCHANOWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 GINGER GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:619-252-3713
Mailing Address - Fax:858-536-7084
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:619-252-3713
Practice Address - Fax:619-810-0620
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20362103T00000X
CA20362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist