Organization
JOSEPH GANNON, PH.D. A PROFESSIONAL PSYCHOLOGY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH PATRICK GANNON PH.D. (PRESIDENT)
(858) 705-5439
Entity
Organization
Contact information
Practice address
4445 EASTGATE MALL PMB 843, SUITE 200, SAN DIEGO, CA 92121-1979
(858) 705-5439
(858) 771-1078
Mailing address
4445 EASTGATE MALL PMB 843, SUITE 200, SAN DIEGO, CA 92121-1979
(858) 705-5439
(858) 771-1078
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
PSY12034
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPL120340
BLUE SHIELD PROVIDER IDEN
CA
Enumeration date
05/31/2006
Last updated
08/28/2024
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