Marian R. C. Edelbrock, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15260 Issued in CA

Practice address

6370 Lusk Blvd
F103
San Diego, CA 92121-2753

Phone

(619) 948-9393

NPI assigned

Sep 7, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223337600000",
    "number": "1255434999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13794 ROSECROFT WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921305106",
            "telephone_number": "619-948-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6370 LUSK BLVD",
            "address_2": "F103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212753",
            "telephone_number": "619-948-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELBROCK",
        "first_name": "MARIAN",
        "middle_name": "R. C.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2008-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY152600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vini Edathara Vijayan
• David Thomas Edberg, M.D., M.A.
• Erika Eddy, MRHS
• George Eddy
• Kyrene Eddy
• Ann Edelman
• Christina Booth Edelman, CNM, WHNP
• Ingrid Kruse Edelman, DPM
• Joni Edelman, LMFT
• Steven V Edelman, M.D.

• 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 Oct 7, 2008; 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.