Provider Demographics
NPI:1033701552
Name:JOSEPH, RENEE A (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3173
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1173
Mailing Address - Country:US
Mailing Address - Phone:347-513-7261
Mailing Address - Fax:
Practice Address - Street 1:14750 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4204
Practice Address - Country:US
Practice Address - Phone:858-904-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 261QM0850X
CAPSY35781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health