Provider Demographics
NPI:1811335128
Name:MICHALOPOULOS, KASIANI
Entity type:Individual
Prefix:
First Name:KASIANI
Middle Name:
Last Name:MICHALOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 CAMINO DEL RIO S STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3704
Mailing Address - Country:US
Mailing Address - Phone:619-363-5699
Mailing Address - Fax:619-354-7341
Practice Address - Street 1:2555 CAMINO DEL RIO S STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-363-5699
Practice Address - Fax:619-354-7341
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30359103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical