Active NPI
Tricia Ann Wolanin, PSY.D.
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1194911024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 22880
- Practice address
- 1145 Gayley Ave Ste 322
Los Angeles, CA 90024-3415 - Phone
- (310) 481-5246
- NPI assigned
- Sep 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 68 016897 | NY | |
| Clinical Psychologist | 103TC0700X | 22880 | CA | Primary |
Addresses
Primary practice location
1145 Gayley Ave Ste 322
Los Angeles, CA 90024-3415
Mailing address
PSC 37 Box 1332
Apo, AE 09459-0014
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68 016897 | NY | MD | Psychologist |
| 22880 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524787200000",
"number": "1194911024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "PSC 37 BOX 1332",
"city": "APO",
"state": "AE",
"postal_code": "094590014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 GAYLEY AVE STE 322",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243415",
"telephone_number": "310-481-5246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLANIN",
"first_name": "TRICIA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-25",
"last_updated": "2018-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "68 016897",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "22880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.