Provider Demographics
NPI:1356362909
Name:SEVERE, NORMAN DALE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DALE
Last Name:SEVERE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2716
Mailing Address - Country:US
Mailing Address - Phone:858-864-2422
Mailing Address - Fax:858-453-5983
Practice Address - Street 1:215 9TH ST
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2716
Practice Address - Country:US
Practice Address - Phone:858-864-2422
Practice Address - Fax:858-453-5983
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY174780Medicaid
CAPSY174780Medicaid
CACP17478Medicare ID - Type UnspecifiedPSYCHOLOGIST