Steve Wysocki, PH.D., PC Dba Alta Loma Psychological Assoc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 6143 Issued in CA

Legal business name

STEVE WYSOCKI, PH.D., PC DBA ALTA LOMA PSYCHOLOGICAL ASSOC

Practice address

9089 Baseline Rd.
#200
Rancho Cucamonga, CA 91730-1295

Phone

(909) 980-3567

Fax

(909) 989-3932

NPI assigned

Mar 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Steve R. Wysocki, PH.D.

Title

Clinical Psychologist

Phone

(909) 980-3567

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236124800000",
    "number": "1003940560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9089 BASELINE RD.",
            "address_2": "#200",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301295",
            "telephone_number": "909-980-3567",
            "fax_number": "909-989-3932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9089 BASELINE RD.",
            "address_2": "#200",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301295",
            "telephone_number": "909-980-3567",
            "fax_number": "909-989-3932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVE WYSOCKI, PH.D., PC DBA ALTA LOMA PSYCHOLOGICAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2009-03-04",
        "status": "A",
        "authorized_official_last_name": "WYSOCKI",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "909-980-3567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 6143",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 16794",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 28102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.