Organization
INTRICATE MIND INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY J BAKER-ERICZEN PH.D. (DIRECTOR)
(858) 205-9809
Entity
Organization
Contact information
Practice address
3990 OLD TOWN AVE STE A207, SAN DIEGO, CA 92110-2967
(858) 205-9809
(858) 205-9809
Mailing address
3990 OLD TOWN AVE STE A207, SAN DIEGO, CA 92110-2967
(858) 205-9809
(858) 205-9809
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
PSY17553
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PSY23448
CA
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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