Provider Demographics
NPI:1790171205
Name:CHENG-WANG, CA-LIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CA-LIE
Middle Name:
Last Name:CHENG-WANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CA-LIE
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2535 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-365-5216
Mailing Address - Fax:937-734-4343
Practice Address - Street 1:2535 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-365-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32645103TC0700X
CA123456390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program