Individual
DR. DANE P CROCKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
990 HIGHLAND DR, STE 110-P, SOLANA BEACH, CA 92075-2408
(310) 308-9761
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 269-0674
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY28313
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY28313
CA
103TF0000X
Family Psychologist
PSY28313
CA
Other
Enumeration date
05/18/2016
Last updated
01/10/2019
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