Larisa Nan Cicila, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29432 Issued in CA

Practice address

2535 Camino del Rio S Ste 106
San Diego, CA 92108-3764

Phone

(619) 940-7774

NPI assigned

Sep 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Diego Psychological Couple Care, Inc.

  • Family Psychologist
  • San Diego, CA
  • NPI 1548881501

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505174400000",
    "number": "1043739915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 31ST ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921044619",
            "telephone_number": "419-494-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 CAMINO DEL RIO S STE 106",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083764",
            "telephone_number": "619-940-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICILA",
        "first_name": "LARISA",
        "middle_name": "NAN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2017-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "PSY29432",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanna Marie Ciafone, APRN
• Natania Nicole Cibrian-Aguilar, LMFT
• Boris Cicak, DC
• Daniel William Cicchelli, P.T.
• Tara Cicchelli, OTR
• Alexa Elena Cid
• Celeste Gabrielle Cid, RBT
• Emily Osborn Cidambi, MD
• Krishna Ravi Cidambi, M.D.
• Alexander Gregory Ciesielski, MD

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.