Individual provider Active NPI

Abby Penson, PH.D.

  • Clinical Psychologist
  • Culver City, CA
National Provider Identifier
1114118270
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY21602 Issued in CA
Practice address
11825 Major St
Suite #207
Culver City, CA 90230-6356
Phone
(323) 580-3383
Fax
(323) 580-3383
NPI assigned
Aug 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY21602 CA Primary

Addresses

Primary practice location

11825 Major St
Suite #207
Culver City, CA 90230-6356

Mailing address

11825 Major St
Suite #207
Culver City, CA 90230-6356
Phone (323) 580-3383

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
I20170906003298 CA Practitioner - Clinical Psychologist 3072788967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11825 Major St
Suite 207
Culver City, CA 90230-6356
Phone (323) 271-1600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY21602CAMDClinical Psychologist
21602CAMDSpeech-Language Pathologist

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": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1114118270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 MAJOR ST",
            "address_2": "SUITE #207",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306356",
            "telephone_number": "323-580-3383",
            "fax_number": "323-908-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11825 MAJOR ST",
            "address_2": "SUITE #207",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306356",
            "telephone_number": "323-580-3383",
            "fax_number": "323-580-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENSON",
        "first_name": "ABBY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.