Active NPI
Kelly Vincent
- Clinical Psychologist
- Encinitas, CA
National Provider Identifier
1053728865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30672
- Practice address
- 169 Saxony Rd Ste 111
Encinitas, CA 92024-6779 - Phone
- (760) 278-8934
- NPI assigned
- Jul 14, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30672 | CA | Primary |
Addresses
Primary practice location
169 Saxony Rd Ste 111
Encinitas, CA 92024-6779
Mailing address
169 Saxony Rd Ste 111
Encinitas, CA 92024-6779
Phone (916) 601-1925
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 10, 2025 through Sep 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30672 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753660800000",
"number": "1053728865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 SAXONY RD STE 111",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "920246779",
"telephone_number": "916-601-1925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 SAXONY RD STE 111",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "920246779",
"telephone_number": "760-278-8934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINCENT",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-14",
"last_updated": "2025-07-28",
"certification_date": "2025-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encinitas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.