Active NPI
Lynne M Virgil, AMFT
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1124726898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 126419
- Practice address
- 11710 San Vicente Blvd
Los Angeles, CA 90049-5006 - Phone
- (855) 651-1580
- NPI assigned
- Feb 21, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 126419 | CA | Primary |
| Marriage & Family Therapist | 106H00000X | 126419 | CA |
Addresses
Primary practice location
11710 San Vicente Blvd
Los Angeles, CA 90049-5006
Mailing address
11710 San Vicente Blvd
Los Angeles, CA 90049-5006
Phone (855) 651-1580
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 |
|---|---|---|---|
| 126419 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1124726898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11710 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495006",
"telephone_number": "855-651-1580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11710 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495006",
"telephone_number": "855-651-1580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIRGIL",
"first_name": "LYNNE",
"middle_name": "M",
"credential": "AMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-21",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "126419",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "126419",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
- Virgil Healthcare (Koreatown Urgent Care)
- Virgil Medical Center Inc
- Virgil Medical Equiptment, Inc.
- Virgil Sanitarium and Convalescent Hospital Inc. (Virgil Convalescent Hospital)
- Chloe Elise Virgil, MD
- Herbert Whiting Virgin-Downey V, MD, MBA
- Virginia Castelo DMD a Dental Corporation
- Virginia Castelo DMD.a Dental Corporation
- Virtual Medical International Inc.
- Jucevi Virtudes, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.