Active NPI
John H Otzenberger, PSY.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1114980307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3099
- Practice address
- 10508 Park Rd
Suite 130
Charlotte, NC 28210-8405 - Phone
- (704) 541-9080
- NPI assigned
- Apr 9, 2006
- 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 | 3099 | NC | Primary |
Addresses
Primary practice location
10508 Park Rd
Suite 130
Charlotte, NC 28210-8405
Mailing address
5100 Lansing Dr
Charlotte, NC 28270-6030
Phone (704) 719-3974
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3099 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1114980307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 LANSING DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282706030",
"telephone_number": "704-719-3974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10508 PARK RD",
"address_2": "SUITE 130",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282108405",
"telephone_number": "704-541-9080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTZENBERGER",
"first_name": "JOHN",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-09",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.