Active NPI
Bodil NMN Sivertsen, PH.D.
- Clinical Psychologist
- Burbank, CA
National Provider Identifier
1154619104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY14068
- Practice address
- 812 S Griffith Park Dr
Burbank, CA 91506-3018 - Phone
- (818) 557-8581
- NPI assigned
- Jul 12, 2011
- Last updated
- Jul 12, 2011
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY14068 | CA | Primary |
Addresses
Primary practice location
812 S Griffith Park Dr
Burbank, CA 91506-3018
Mailing address
812 S Griffith Park Dr
Burbank, CA 91506-3018
Phone (818) 557-8581
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY14068 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310428800000",
"number": "1154619104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "812 S GRIFFITH PARK DR",
"city": "BURBANK",
"state": "CA",
"postal_code": "915063018",
"telephone_number": "818-557-8581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "812 S GRIFFITH PARK DR",
"city": "BURBANK",
"state": "CA",
"postal_code": "915063018",
"telephone_number": "818-557-8581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIVERTSEN",
"first_name": "BODIL",
"middle_name": "NMN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-12",
"last_updated": "2011-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY14068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.