Active NPI
Charlotte Modahl, PH.D.
- Clinical Psychologist
- Cypress, CA
National Provider Identifier
1205163847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10375
- Practice address
- 1601 Ball Rd
#304
Cypress, CA 90630 - Phone
- (562) 431-8822
- Fax
- (562) 431-8875
- NPI assigned
- Nov 3, 2009
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY10375 | CA | Primary |
Addresses
Primary practice location
1601 Ball Rd
#304
Cypress, CA 90630
Mailing address
3121 W Coast Hwy
3A
Newport Beach, CA 92663-4022
Phone (949) 642-2041
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP103750 | Other | MEDICARE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY10375 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288828800000",
"number": "1205163847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3121 W COAST HWY",
"address_2": "3A",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926634022",
"telephone_number": "949-642-2041",
"fax_number": "949-642-2076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 BALL RD",
"address_2": "#304",
"city": "CYPRESS",
"state": "CA",
"postal_code": "90630",
"telephone_number": "562-431-8822",
"fax_number": "562-431-8875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODAHL",
"first_name": "CHARLOTTE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-03",
"last_updated": "2010-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY10375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "CP103750",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cypress, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.