Provider Demographics
NPI:1851731079
Name:SAN DIEGO CENTER FOR NEUROFEEDBACK
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:KATARINA
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-448-1216
Mailing Address - Street 1:12064 WOODSIDE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2951
Mailing Address - Country:US
Mailing Address - Phone:619-448-1216
Mailing Address - Fax:
Practice Address - Street 1:12064 WOODSIDE AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2951
Practice Address - Country:US
Practice Address - Phone:619-448-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty