Provider Demographics
NPI:1902976343
Name:CARBONELL, SONIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 MISSION GORGE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-282-4270
Mailing Address - Fax:619-282-4272
Practice Address - Street 1:6136 MISSION GORGE RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3494
Practice Address - Country:US
Practice Address - Phone:619-282-4270
Practice Address - Fax:619-282-4272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1744103TC2200X
CA19752103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902976343Medicaid