Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY14889 | CA |
N | 103T00000X | Psychologist | PSY14889 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY14889 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY14889 | CA |
Y | 103G00000X | Clinical Psychologist | PSY14889 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY14889 | CA |
N | 103TP2701X | Group Psychotherapist | PSY14889 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY14889 | CA |
NPI | 1366437691 |
---|---|
Provider Name | Valerie Jay Pearson |
First Address | San Diego, CA 92103-4206 |
Second Address | San Diego, CA 92103-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5883430 | MEDI CAL IDENTIFIER (01) | CA |