Individual provider Active NPI

Nika Kalynovska

  • Clinical Psychologist
  • Provo, UT
National Provider Identifier
1215486402
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5214 Issued in CT
Practice address
1300 E Center St
Provo, UT 84606-3554
Phone
(801) 344-4400
NPI assigned
Sep 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5214 CT Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1300 E Center St
Provo, UT 84606-3554

Mailing address

15339 Saticoy St
Van Nuys, CA 91406-3345
Phone (818) 267-2681

Other practice location 1

15339 Saticoy St
Van Nuys, CA 91406
Phone (818) 267-2681

Other practice location 2

1000 W Carson St
Torrance, CA 90502-2004
Phone (909) 653-0870

Other practice location 3

609 W Johnson Ave Ste 104
Cheshire, CT 06410-4506
Phone (203) 272-6007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20250918001343 CT Practitioner - Clinical Psychologist 5597269936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Neuropsychology LLCGroup PAC ID 3375602931, 16 clinicians

Practice addresses (Care Compare)

609 W Johnson Ave
Suite 104
Cheshire, CT 06410-4506
Phone (203) 272-6007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
5214CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Neuropsychology, LLC CurrentSince Oct 1, 2025 Accepting new patients
Advanced Telepsych PLLC PastSince Jan 1, 2024 Accepting new patients

Locations

609 W Johnson Ave
Ste 104
Cheshire, CT 06410
Phone (203) 272-6007

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1215486402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15339 SATICOY ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914063345",
            "telephone_number": "818-267-2681",
            "fax_number": "818-267-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15339 Saticoy St",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "91406",
            "country_code": "US",
            "telephone_number": "818-267-2681",
            "fax_number": "818-267-2771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W Carson St",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022004",
            "country_code": "US",
            "telephone_number": "909-653-0870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "609 W Johnson Ave Ste 104",
            "address_purpose": "LOCATION",
            "city": "Cheshire",
            "state": "CT",
            "postal_code": "064104506",
            "country_code": "US",
            "telephone_number": "203-272-6007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALYNOVSKA",
        "first_name": "NIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "5214",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.