Active NPI
Carol Povenmire, PH.D.
- Psychologist
- Pasadena, CA
National Provider Identifier
1194878165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY10257
- Practice address
- 960 E Green St
Suite 290
Pasadena, CA 91106-2401 - Phone
- (626) 355-2630
- NPI assigned
- Jan 20, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY10257 | CA | Primary |
Addresses
Primary practice location
960 E Green St
Suite 290
Pasadena, CA 91106-2401
Mailing address
PO Box 295
Sierra Madre, CA 91025-0295
Phone (626) 355-2630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10257 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194878165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 295",
"city": "SIERRA MADRE",
"state": "CA",
"postal_code": "910250295",
"telephone_number": "626-355-2630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 E GREEN ST",
"address_2": "SUITE 290",
"city": "PASADENA",
"state": "CA",
"postal_code": "911062401",
"telephone_number": "626-355-2630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POVENMIRE",
"first_name": "CAROL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY10257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.