Provider Demographics
NPI:1831479534
Name:PEARSON, AIMEE CORNELIUS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:CORNELIUS
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE STE B100
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:619-647-5592
Mailing Address - Fax:619-299-9089
Practice Address - Street 1:3990 OLD TOWN AVE STE B100
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:619-647-5592
Practice Address - Fax:619-299-9089
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical