Provider Demographics
NPI:1902074693
Name:PSYCHOLOGICAL MANAGEMENT RESOURCES, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL MANAGEMENT RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-449-1953
Mailing Address - Street 1:9340 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2161
Mailing Address - Country:US
Mailing Address - Phone:858-449-1953
Mailing Address - Fax:858-538-1661
Practice Address - Street 1:9340 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2161
Practice Address - Country:US
Practice Address - Phone:858-449-1953
Practice Address - Fax:858-538-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty