Provider Demographics
NPI:1851756001
Name:SJC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SJC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COVELLUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-342-4155
Mailing Address - Street 1:2333 CAMINO DEL RIO S STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3617
Mailing Address - Country:US
Mailing Address - Phone:619-342-4155
Mailing Address - Fax:
Practice Address - Street 1:2333 CAMINO DE RIO S
Practice Address - Street 2:160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-342-4155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty