Active NPI
Charles Clint Patterson, PHD
- Clinical Psychologist
- Rolling Hills, CA
National Provider Identifier
1114108685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY12399
- Practice address
- 22 Georgeff Rd
Rolling Hills, CA 90274-5269 - Phone
- (310) 944-1420
- Fax
- (310) 541-3062
- NPI assigned
- Nov 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY12399 | CA | Primary |
Addresses
Primary practice location
22 Georgeff Rd
Rolling Hills, CA 90274-5269
Mailing address
22 Georgeff Rd
Rolling Hills, CA 90274-5269
Phone (310) 944-1420
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12399 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196035200000",
"number": "1114108685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 GEORGEFF RD",
"city": "ROLLING HILLS",
"state": "CA",
"postal_code": "902745269",
"telephone_number": "310-944-1420",
"fax_number": "310-541-3062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 GEORGEFF RD",
"city": "ROLLING HILLS",
"state": "CA",
"postal_code": "902745269",
"telephone_number": "310-944-1420",
"fax_number": "310-541-3062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "CHARLES",
"middle_name": "CLINT",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-26",
"last_updated": "2007-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY12399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolling Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.