Active NPI
Doreen Ann Samelson, EDD, MSCP
- Psychologist
- Tracy, CA
National Provider Identifier
1154491736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY16868
- Practice address
- 2185 W Grant Line Rd
Tracy, CA 95377-7309 - Phone
- (209) 839-6233
- Fax
- (209) 839-6246
- NPI assigned
- Nov 9, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY16868 | CA | Primary |
Addresses
Primary practice location
2185 W Grant Line Rd
Tracy, CA 95377-7309
Mailing address
2185 W Grant Line Rd
Tracy, CA 95377-7309
Phone (209) 839-6233
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154491736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2185 W GRANT LINE RD",
"city": "TRACY",
"state": "CA",
"postal_code": "953777309",
"telephone_number": "209-839-6233",
"fax_number": "209-839-6246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2185 W GRANT LINE RD",
"city": "TRACY",
"state": "CA",
"postal_code": "953777309",
"telephone_number": "209-839-6233",
"fax_number": "209-839-6246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMELSON",
"first_name": "DOREEN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "EDD, MSCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY16868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.