Provider Demographics
NPI:1952651507
Name:DUENAS, CECILIA (PSY)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:DUENAS
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:DR
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:DUENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PYSD
Mailing Address - Street 1:6996 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5155
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:858-467-7161
Practice Address - Street 1:4550 KEARNY VILLA RD
Practice Address - Street 2:STE 116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1578
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:858-467-7161
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25519103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent