Individual provider Active NPI

Candace Ward-McKinlay, PH.D.

  • Counseling Psychologist
  • Alpine, CA
National Provider Identifier
1104991322
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PSY7379 Issued in CA
Practice address
2271 Alpine Blvd Ste a
Alpine, CA 91901-1101
Phone
(203) 848-9716
NPI assigned
Nov 22, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PSY7379 CA Primary

Addresses

Primary practice location

2271 Alpine Blvd Ste a
Alpine, CA 91901-1101

Mailing address

2966 Night Watch Way
Alpine, CA 91901-4115
Phone (203) 848-9716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200723003893 CA Practitioner - Clinical Psychologist 0244654192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2271 Alpine Blvd
Suite a
Alpine, CA 91901-1101
Phone (619) 448-1216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY7379CAMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fusion Care Group, a Psychological Professional Corporation Psychologist CurrentSince Mar 24, 2020 Accepting new patients

Locations

2271 Alpine Blvd
Ste A
Alpine, CA 91901
Phone (619) 289-7322

2124 S El Camino Real
Ste 101
Oceanside, CA 92054
Phone (760) 405-4787

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1104991322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2966 NIGHT WATCH WAY",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919014115",
            "telephone_number": "203-848-9716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2271 ALPINE BLVD STE A",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011101",
            "telephone_number": "203-848-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARD-MCKINLAY",
        "first_name": "CANDACE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY7379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpine, CA

Sources for this page

Verify at the official NPI Registry.