Active NPI
Peter Nicholson Maduro, J.D., PSY.D.
- Clinical Psychologist
- Beverly Hills, CA
National Provider Identifier
1245425081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 19531
- Practice address
- 450 N Bedford Dr
Suite 302
Beverly Hills, CA 90210-4324 - Phone
- (310) 858-6455
- Fax
- (310) 442-9508
- NPI assigned
- Sep 13, 2007
- Last updated
- Sep 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 19531 | CA | Primary |
| Counseling Psychologist | 103TC1900X | 19531 | CA | |
| Forensic Psychologist | 103TF0200X | 19531 | CA | |
| Psychoanalysis Psychologist | 103TP0814X | 19531 | CA |
Addresses
Primary practice location
450 N Bedford Dr
Suite 302
Beverly Hills, CA 90210-4324
Mailing address
450 N Bedford Dr
Suite 302
Beverly Hills, CA 90210-4324
Phone (310) 858-6455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 4, 2021 through Oct 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Juris Doctor
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19531 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189641600000",
"number": "1245425081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 N BEDFORD DR",
"address_2": "SUITE 302",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902104324",
"telephone_number": "310-858-6455",
"fax_number": "310-442-9508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 N BEDFORD DR",
"address_2": "SUITE 302",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902104324",
"telephone_number": "310-858-6455",
"fax_number": "310-442-9508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADURO",
"first_name": "PETER",
"middle_name": "NICHOLSON",
"name_prefix": "Dr.",
"credential": "J.D., PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-13",
"last_updated": "2007-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "19531",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CA",
"license": "19531",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "19531",
"primary": false
},
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": "CA",
"license": "19531",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beverly Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.