Provider Demographics
NPI:1780697250
Name:COMMENTZ, DENISE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:COMMENTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:PROF
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:COMMENTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:372 LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2531
Mailing Address - Country:US
Mailing Address - Phone:760-942-6371
Mailing Address - Fax:
Practice Address - Street 1:372 LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2531
Practice Address - Country:US
Practice Address - Phone:760-942-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14314103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY14314Medicaid
CACP14314AMedicare ID - Type Unspecified