Provider Demographics
NPI:1255710893
Name:QUISENBERRY, CAROLYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:QUISENBERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 POMERADO RD STE B3
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2425
Mailing Address - Country:US
Mailing Address - Phone:760-607-6463
Mailing Address - Fax:760-607-3433
Practice Address - Street 1:15525 POMERADO RD STE B3
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2425
Practice Address - Country:US
Practice Address - Phone:760-607-6463
Practice Address - Fax:760-607-3433
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 103TC2200X, 103TF0000X
CA29419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily