Provider Demographics
NPI:1750379400
Name:CORINNA YOUNG CASEY PH D PSYCHOLOGY
Entity type:Organization
Organization Name:CORINNA YOUNG CASEY PH D PSYCHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-794-9413
Mailing Address - Street 1:2262 CARMEL VALLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3751
Mailing Address - Country:US
Mailing Address - Phone:858-794-9413
Mailing Address - Fax:858-876-3128
Practice Address - Street 1:2262 CARMEL VALLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3751
Practice Address - Country:US
Practice Address - Phone:858-794-9413
Practice Address - Fax:858-876-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20004103TH0100X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty