NPIMap

Organization Active NPI

San Diego Family Services

  • Clinical Psychologist
  • Del Mar, CA
National Provider Identifier
1720101082
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SAN DIEGO FAMILY SERVICES
Practice address
1104 Camino del Mar
Suite 107
Del Mar, CA 92014-2656
Phone
(877) 880-7337
Fax
(858) 923-1121
NPI assigned
Apr 9, 2007
Last updated
Jan 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

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

Authorized official

Name
Dr. Christy Wise, PSY.D.NPI 1407839012
Title
Director
Phone
(877) 880-7337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Exercise & Sports PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TE1100X
Family PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0000X
Forensic PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0200X
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X

Addresses

Primary practice location

1104 Camino del Mar
Suite 107
Del Mar, CA 92014-2656

Mailing address

1104 Camino del Mar
Suite 107
Del Mar, CA 92014-2656
Phone (877) 880-7337

National Provider Directory

National Provider Directory

Locations

1104 Camino del Mar
Ste 107
Del Mar, CA 92014
Phone (877) 880-7337

6540 Lusk Blvd
Ste C135
San Diego, CA 92121
Phone (858) 729-0692

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1720101082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 CAMINO DEL MAR",
            "address_2": "SUITE 107",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142656",
            "telephone_number": "877-880-7337",
            "fax_number": "858-923-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 CAMINO DEL MAR",
            "address_2": "SUITE 107",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142656",
            "telephone_number": "877-880-7337",
            "fax_number": "858-923-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-880-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Del Mar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; 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.