Provider Demographics
NPI:1942311238
Name:SCHWARTZ, NANCY GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:GRACE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CAMINO DEL RIO S STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3611
Mailing Address - Country:US
Mailing Address - Phone:619-297-8111
Mailing Address - Fax:619-220-0437
Practice Address - Street 1:2221 CAMINO DEL RIO S STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3611
Practice Address - Country:US
Practice Address - Phone:619-297-8111
Practice Address - Fax:619-220-0437
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5707Medicare UPIN