Active NPI
Leonard B Medoff, PHD
- Clinical Psychologist
- Fort Collins, CO
National Provider Identifier
1164576559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 708
- Practice address
- 1217 E Elizabeth BLDG 6
Fort Collins, CO 80524 - Phone
- (970) 484-0663
- Fax
- (970) 221-2446
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 708 | CO | Primary |
Addresses
Primary practice location
1217 E Elizabeth BLDG 6
Fort Collins, CO 80524
Mailing address
1217 E Elizabeth BLDG 6
Fort Collins, CO 80524
Phone (970) 484-0663
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 |
|---|---|---|---|
| 708 | CO | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164576559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1217 E ELIZABETH BLDG 6",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "80524",
"telephone_number": "970-484-0663",
"fax_number": "970-221-2446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 E ELIZABETH BLDG 6",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "80524",
"telephone_number": "970-484-0663",
"fax_number": "970-221-2446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDOFF",
"first_name": "LEONARD",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
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.