Kimberly Lisa Vander Dussen, PSY. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY17209 Issued in CA

Practice address

101 S Kraemer Blvd Ste 236
Placentia, CA 92870-6102

Phone

(714) 329-6080

Fax

(714) 491-7215

NPI assigned

Jan 18, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vander Dussen & Associates Psychological Corporation

  • Psychologist
  • Placentia, CA
  • NPI 1508780594
  NPD (past) Authorized official

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003968066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S KRAEMER BLVD STE 236",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928706102",
            "telephone_number": "714-329-6080",
            "fax_number": "714-491-7215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S KRAEMER BLVD STE 236",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928706102",
            "telephone_number": "714-329-6080",
            "fax_number": "714-491-7215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER DUSSEN",
        "first_name": "KIMBERLY",
        "middle_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Rene Valencia, M.S., OTR/L
• Paola Fernanda Vallejo
• Kayla Van Dieren, PTA
• Van T. Nguyen DMD Corp
• Vander Dussen & Associates Psychological Corporation
• Martha Irene Vandeventer, R.N.
• Susan Varghese, PH.D, LPCC
• Liza Marie Vasquez
• Alyssa Danielle Velasco
• Aileen Melodie Velasquez, FNP-BC

• Clinical Psychologist in Placentia, CA
• Providers in Placentia, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.