Provider Demographics
NPI:1891201281
Name:FAMILY VIOLENCE AND SEXUAL ASSAULT INSTITUTE
Entity Type:Organization
Organization Name:FAMILY VIOLENCE AND SEXUAL ASSAULT INSTITUTE
Other - Org Name:INSTITUTE ON VIOLENCE, ABUSE, AND TRAUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-771-6967
Mailing Address - Street 1:10065 OLD GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1664
Mailing Address - Country:US
Mailing Address - Phone:858-771-7169
Mailing Address - Fax:
Practice Address - Street 1:10065 OLD GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1664
Practice Address - Country:US
Practice Address - Phone:858-771-7169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty