Active NPI
Amy Wiseman, PSY.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1124567763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY30036
- Practice address
- 8170 Beverly Blvd Ste 106
Los Angeles, CA 90048-4533 - Phone
- (310) 750-4490
- NPI assigned
- Feb 15, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY30036 | CA | Primary |
Addresses
Primary practice location
8170 Beverly Blvd Ste 106
Los Angeles, CA 90048-4533
Mailing address
1609 101St St S
Tacoma, WA 98444-2819
Phone (512) 820-7193
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30036 | CA | MD | Psychologist |
| 30036 | CA | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1124567763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1609 101ST ST S",
"city": "TACOMA",
"state": "WA",
"postal_code": "984442819",
"telephone_number": "512-820-7193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8170 BEVERLY BLVD STE 106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484533",
"telephone_number": "310-750-4490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "AMY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-15",
"last_updated": "2024-07-15",
"certification_date": "2024-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY30036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.