Provider Demographics
NPI:1205121449
Name:UCSD DEPT. OF PSYCHIATRY
Entity type:Organization
Organization Name:UCSD DEPT. OF PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESCHLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-543-6243
Mailing Address - Street 1:140 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2007
Mailing Address - Country:US
Mailing Address - Phone:619-543-7625
Mailing Address - Fax:619-543-7357
Practice Address - Street 1:140 ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2007
Practice Address - Country:US
Practice Address - Phone:619-543-7625
Practice Address - Fax:619-543-7357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCSD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit