Provider Demographics
NPI:1245630789
Name:PRICE, ADAM D (MA, BCBA 1-14-15803)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:D
Last Name:PRICE
Suffix:
Gender:M
Credentials:MA, BCBA 1-14-15803
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10065 OLD GROVE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-444-8823
Mailing Address - Fax:858-444-8827
Practice Address - Street 1:10065 OLD GROVE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-444-8823
Practice Address - Fax:858-444-8827
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist