Active NPI
Hrysso Kellas Fernbach, PSY. D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1225232697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 26472
- Practice address
- 2668 W Canyon Ave
San Diego, CA 92123-4684 - Phone
- (732) 770-5360
- NPI assigned
- Jun 12, 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2705 | NJ | |
| Clinical Psychologist | 103TC0700X | 9329 | NY | |
| Clinical Psychologist | 103TC0700X | 8643 | FL | |
| Clinical Psychologist | 103TC0700X | 26472 | CA | Primary |
Addresses
Primary practice location
2668 W Canyon Ave
San Diego, CA 92123-4684
Mailing address
2668 W Canyon Ave
San Diego, CA 92123-4684
Phone (732) 770-5360
Other practice location 1
40 Stafford Rd
Colonia, NJ 07067-3209
Phone (732) 770-5360
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2705 | Other | NJ | PSYCHOLOGY LICENSE |
| PY8643 | Other | FL | PSYCHOLOGY LICENSE |
| 9329 | Other | NY | PSYCHOLOGY LICENSE |
| 26472 | Other | CA | PSYCHOLOGY LICENSE |
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 |
|---|---|---|---|
| 2705 | NJ | MD | Psychologist |
| 8643 | FL | MD | Clinical Psychologist |
| 9329 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568246400000",
"number": "1225232697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2668 W CANYON AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234684",
"telephone_number": "732-770-5360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2668 W CANYON AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234684",
"telephone_number": "732-770-5360"
}
],
"practiceLocations": [
{
"address_1": "40 Stafford Rd",
"address_purpose": "LOCATION",
"city": "Colonia",
"state": "NJ",
"postal_code": "070673209",
"country_code": "US",
"telephone_number": "732-770-5360",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FERNBACH",
"first_name": "HRYSSO",
"middle_name": "KELLAS",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-12",
"last_updated": "2019-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "2705",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "9329",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "8643",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "26472",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "2705",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "PY8643",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "9329",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "26472",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.