Provider Demographics
NPI:1790329613
Name:GROWGOOD PSYCHOLOGY, CORP
Entity Type:Organization
Organization Name:GROWGOOD PSYCHOLOGY, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:760-505-2985
Mailing Address - Street 1:1551 UNION ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3439
Mailing Address - Country:US
Mailing Address - Phone:760-505-2985
Mailing Address - Fax:619-793-1492
Practice Address - Street 1:3405 KENYON ST # 513-06
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5003
Practice Address - Country:US
Practice Address - Phone:858-480-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty