Hildy Kellman Agustin, PSY.D.
Individual provider Active NPI Clinical Psychologist · Menlo Park, CA
NPI 1124213764 · NPPES record last updated Sep 6, 2007
Key facts
- NPI
- 1124213764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 19060 (CA)
- Practice address
- 830 Menlo Ave
Suite 105
Menlo Park, CA 94025-4751 - Phone
- (650) 321-1788
- Fax
- (650) 321-8845
- NPI assigned
- Sep 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2019 through Jan 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19060 | CA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 19060 | CA | |
| Clinical Psychologist | 103TC0700X | 19060 | CA | Yes |
Addresses
Primary practice location
830 Menlo Ave
Suite 105
Menlo Park, CA 94025-4751
Mailing address
830 Menlo Ave
Suite 105
Menlo Park, CA 94025-4751
Phone (650) 321-1788
Other providers in Menlo Park, CA
- Andenika Nicole Adams
- Kelli Adams
- Addiction Research and Treatment, Inc
- Emeira Jose Adler
- Alexandra Lee Aguilar
- Sana Ahmed
- Alan K Newman DDS PC
- Kai Briana Alexander
- Fathima Ali
- Anne Allclair
All providers in Menlo Park, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.