Provider Demographics
NPI:1235464272
Name:DAVID, JOAN R (PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:R
Last Name:DAVID
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 1:9550 WARNER AVE
Mailing Address - Street 2:SUITE 250-05
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5644
Mailing Address - Country:US
Mailing Address - Phone:714-593-2355
Mailing Address - Fax:714-593-2395
Practice Address - Street 1:9550 WARNER AVE
Practice Address - Street 2:SUITE 250-05
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5644
Practice Address - Country:US
Practice Address - Phone:714-593-2355
Practice Address - Fax:714-593-2395
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY229228103T00000X, 103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent