Individual provider Active NPI

Genevieve Andrade

  • Clinical Psychologist
  • Long Beach, CA
National Provider Identifier
1124158027
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY29019 Issued in CA
Practice address
2931 Redondo Ave
Long Beach, CA 90806-2445
Phone
(562) 490-7600
Fax
(562) 490-7601
NPI assigned
Mar 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY29019 CA Primary
Rehabilitation Practitioner 225400000X

Addresses

Primary practice location

2931 Redondo Ave
Long Beach, CA 90806-2445

Mailing address

616 Heliotrope Ave
Corona del Mar, CA 92625-2219
Phone (949) 533-9307

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
I20180426001206 CA Practitioner - Clinical Psychologist 4486918547 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY29019CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Memory Check Psychological Services, a Professional Corporation Clinical CurrentSince Apr 17, 2018 Accepting new patients

Locations

5838 Edison Pl
Ste 100
Carlsbad, CA 92008
Phone (760) 300-3664

348 Iris Dr
Salinas, CA 93906
Phone (831) 449-5496

7447 Sepulveda Blvd
Van Nuys, CA 91405
Phone (818) 787-3400

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": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1124158027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 HELIOTROPE AVE",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926252219",
            "telephone_number": "949-533-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062445",
            "telephone_number": "562-490-7600",
            "fax_number": "562-490-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRADE",
        "first_name": "GENEVIEVE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29019",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.