Ricardo Carrillo, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY11696 Issued in CA

Practice address

2576 Shattuck Ave Ste 3
Berkeley, CA 94704-2724

Phone

(559) 804-1671

Fax

(888) 733-0664

NPI assigned

Sep 11, 2008

Last updated

Mar 2, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Ehab Yacoub MD Inc.

  dba Brain Health USA

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment NPD

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1225287568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 ADAMS CT",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642336",
            "telephone_number": "559-804-1671",
            "fax_number": "888-733-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2576 SHATTUCK AVE STE 3",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042724",
            "telephone_number": "559-804-1671",
            "fax_number": "888-733-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "RICARDO",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-11",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY11696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William L Carpenter
• Anthony Peter Carpentieri, MFT
• Dana Carr, PSYD
• Kaiulani Rosemary Jane Carreiro, MEDICAL ASSISTANT
• Carrie Katz, Licensed Marriage and Family Therapist, Inc.
• Madeline Carrington
• Charkeia Carroll, LMFT
• Kaitlyn Dawn Carrow
• Laura L. Carstensen, PH.D.
• Tasha Carter-Gordon

• Psychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.