Provider Demographics
NPI:1184611576
Name:KUCK, JULIA (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:KUCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4147 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2509
Mailing Address - Country:US
Mailing Address - Phone:619-281-1932
Mailing Address - Fax:619-281-1947
Practice Address - Street 1:4147 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2509
Practice Address - Country:US
Practice Address - Phone:619-281-1932
Practice Address - Fax:619-281-1947
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14060103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY14060OtherPSYCHOLOGY BOARD LICENSE
CACP14060AMedicare PIN