Provider Demographics
NPI:1770764847
Name:J ROLAND FLECK
Entity type:Organization
Organization Name:J ROLAND FLECK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:760-942-1210
Mailing Address - Street 1:4405 MANCHESTER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4940
Mailing Address - Country:US
Mailing Address - Phone:760-942-1210
Mailing Address - Fax:760-942-3865
Practice Address - Street 1:4405 MANCHESTER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4940
Practice Address - Country:US
Practice Address - Phone:760-942-1210
Practice Address - Fax:760-942-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5502103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5502Medicare PIN