Tara C Booth, PSY. D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY19590 Issued in CA

Practice address

1675 Morena Blvd
Suite 100
San Diego, CA 92110-3703

Phone

(619) 275-8000

Fax

(619) 275-8005

NPI assigned

Nov 22, 2006

Sex

Female

Sole proprietor

No

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 Medicine

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.

• Telecare Corporation

  • Mental Illness Community Based Residential Treatment Facility
  • San Diego, CA
  • NPI 1275398935
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383868800000",
    "number": "1346315447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 MORENA BLVD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103703",
            "telephone_number": "619-275-8000",
            "fax_number": "619-275-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 MORENA BLVD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103703",
            "telephone_number": "619-275-8000",
            "fax_number": "619-275-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "TARA",
        "middle_name": "C",
        "credential": "PSY. D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY19590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1512013461",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Booth
• Lakota Booth
• Laura A Booth, RN, MS, CNS, ANP-BC
• Lauren Elyse Booth
• Melissa Kristine Booth
• Tegan Booz
• Cathy A Boppert, P.T.
• Cameron Boquet, AMFT
• Andres Ivan Boquiren
• Cynthia Bor

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.