Provider Demographics
NPI:1689745861
Name:CASEY, CORINNA YOUNG (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:YOUNG
Last Name:CASEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CORINNA
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2262 CARMEL VALLEY RD
Mailing Address - Street 2:STE E
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3751
Mailing Address - Country:US
Mailing Address - Phone:858-794-9413
Mailing Address - Fax:858-876-3128
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:858-794-9413
Practice Address - Fax:858-876-3128
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20004103TC0700X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL200040OtherBLUE SHIELD
CA374834OtherMHN
CA5674288OtherFIRST HEALTH
CAWCP20004AMedicare ID - Type Unspecified