Active NPI
Donald Phillip McKillop, PH.D.
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1194815407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 3041
- Practice address
- 2820 Adeline St
Berkeley, CA 94703-2264 - Phone
- (510) 848-5574
- Fax
- (510) 339-6477
- NPI assigned
- Oct 15, 2006
- Sex
- Male
- 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 | PSY 3041 | CA | Primary |
Addresses
Primary practice location
2820 Adeline St
Berkeley, CA 94703-2264
Mailing address
2820 Adeline St
Berkeley, CA 94703-2264
Phone (510) 848-5574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY3041 | Other | CA | LICENSED PSYCHOLOGIST |
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 |
|---|---|---|---|
| PSY 3041 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194815407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2820 ADELINE ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947032264",
"telephone_number": "510-848-5574",
"fax_number": "510-339-6477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2820 ADELINE ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947032264",
"telephone_number": "510-848-5574",
"fax_number": "510-339-6477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKILLOP",
"first_name": "DONALD",
"middle_name": "PHILLIP",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 3041",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED PSYCHOLOGIST",
"identifier": "PSY3041",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, 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.