Provider Demographics
NPI:1790304947
Name:DUET PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:DUET PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-794-4229
Mailing Address - Street 1:3990 OLD TOWN AVE STE A208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2967
Mailing Address - Country:US
Mailing Address - Phone:619-794-4229
Mailing Address - Fax:619-330-2003
Practice Address - Street 1:3990 OLD TOWN AVE STE A208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2967
Practice Address - Country:US
Practice Address - Phone:619-794-4229
Practice Address - Fax:619-330-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty