Provider Demographics
NPI:1912981879
Name:SISKOWIC, SHIRLEY J (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:J
Last Name:SISKOWIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 RIVIERA DR
Mailing Address - Street 2:UNIT 603
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5829
Mailing Address - Country:US
Mailing Address - Phone:858-270-4010
Mailing Address - Fax:
Practice Address - Street 1:4550 KEARNY VILLA RD
Practice Address - Street 2:PSYCARE STE.116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1578
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:858-279-6154
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSYCHOLOGY 18442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health