Jacob Andrew Paulsen, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

34892 Issued in CA

Practice address

111 Elm St
San Diego, CA 92101-2692

Phone

(619) 800-5499

NPI assigned

Jan 28, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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.

• Dr Jacob Andrew Paulsen PHD Licensed Clinical Psychologist Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1912723404
  NPD Authorized official

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732838400000",
    "number": "1578027199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3573",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921631573",
            "telephone_number": "619-800-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ELM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012692",
            "telephone_number": "619-800-5499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9620 Chesapeake Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921231369",
            "country_code": "US",
            "telephone_number": "619-814-6590",
            "fax_number": "619-528-4625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAULSEN",
        "first_name": "JACOB",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-28",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "34892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Paulk
• Megan Ann Paulk, AUD
• Pier Paulo, L.AC.
• Angel Manahel Pauls
• John David Pauls, M.D
• Sarah Marie Paulsen
• Annette Paulson
• Brandon Michael Paulson
• Kristin Legvold Paulson, PA-C
• Madeline Paulson

• 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 Nov 29, 2024; 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.