Active NPI
Michael Bormacoff Jr., PSYD
- Clinical Psychologist
- Atascadero, CA
National Provider Identifier
1053968552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 31169
- Practice address
- 10333 El Camino Real
Atascadero, CA 93422-5808 - Phone
- (805) 468-2045
- NPI assigned
- Aug 20, 2019
- Sex
- Male
- 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 | 31169 | CA | Primary |
Addresses
Primary practice location
10333 El Camino Real
Atascadero, CA 93422-5808
Mailing address
10333 El Camino Real
Atascadero, CA 93422-5808
Phone (805) 468-2045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566518400000",
"number": "1053968552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10333 EL CAMINO REAL",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225808",
"telephone_number": "805-468-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10333 EL CAMINO REAL",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225808",
"telephone_number": "805-468-2045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORMACOFF",
"first_name": "MICHAEL",
"name_suffix": "Jr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-20",
"last_updated": "2019-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "31169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.