Provider Demographics
NPI:1700054012
Name:WORTHINGTON, GEORGE BARROW III (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BARROW
Last Name:WORTHINGTON
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:WORTHINGTON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10505 SORRENTO VALLEY RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1618
Mailing Address - Country:US
Mailing Address - Phone:858-729-0692
Mailing Address - Fax:858-638-1576
Practice Address - Street 1:10505 SORRENTO VALLEY RD.
Practice Address - Street 2:SUITE 450
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-729-0692
Practice Address - Fax:858-638-1576
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11909103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR16445Medicare UPIN