Provider Demographics
NPI:1245458132
Name:KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.
Entity type:Organization
Organization Name:KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:FARA
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MFT
Authorized Official - Phone:619-298-0169
Mailing Address - Street 1:6757 FRIARS RD UNIT 21
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5013
Mailing Address - Country:US
Mailing Address - Phone:619-298-0169
Mailing Address - Fax:619-298-0169
Practice Address - Street 1:4411 30TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4286
Practice Address - Country:US
Practice Address - Phone:619-298-2098
Practice Address - Fax:619-298-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39583106H00000X
CAPSY21669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA352923OtherCIGNA
CA7314642OtherAETNA
CAMFC395830OtherBLUE SHIELD AND TRICARE