Diane Renee Kelley, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12962 Issued in CA

Practice address

1021 N Sepulveda Blvd
Suite H
Manhattan Beach, CA 90266-5965

Phone

(310) 559-3164

Fax

(310) 802-8856

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456876800000",
    "number": "1194819797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 N SEPULVEDA BLVD",
            "address_2": "SUITE H",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665965",
            "telephone_number": "310-559-3164",
            "fax_number": "310-802-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 N SEPULVEDA BLVD",
            "address_2": "SUITE H",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665965",
            "telephone_number": "310-559-3164",
            "fax_number": "310-802-8856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "DIANE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2016-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12962",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC5783",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Carol Kawamura, OD
• Rosanne Kay, MD
• Susan Kaye, FNP
• Caroline Fisher Keck
• Keith S. Feder MD, Inc.
• Lea Kelley, D.C., L.AC.
• Marie Rusher Kelley, M.D.
• Kelly Psychiatric Associates, Inc.
• Patrick Michael Kelly, MD
• Ella Kenney

• Clinical Psychologist in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.