Angie Susana Pelletier-Juarez, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

34099 Issued in CA

Practice address

17401 Vintage St
Northridge, CA 91325-1538

Phone

(323) 559-2836

NPI assigned

Sep 19, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Angie Susana Juarez Former name

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychologist

  Medicare reassignment NPD

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1275883084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17401 VINTAGE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251538",
            "telephone_number": "323-559-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17401 VINTAGE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251538",
            "telephone_number": "323-559-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETIER-JUAREZ",
        "first_name": "ANGIE",
        "middle_name": "SUSANA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "34099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGIE",
            "last_name": "JUAREZ",
            "middle_name": "SUSANA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ma. Risa Therese A Pedrina
• Sherbanoo A Peermahomed, M.D.
• Richard Fernando Pego, MD
• Jennifer Pelayo
• Rosemary Pelayo
• Jennifer V Pemberton
• Asor Pena
• Geraldine Pena
• Hector Penagos, BA
• Jeniffer Consuelo Penalber

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.