Active NPI
John E. Thvedt, EDD
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1295747079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS 008371L
- Practice address
- 4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680 - Phone
- (800) 257-8715
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS 008371L | PA | Primary |
Addresses
Primary practice location
4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680
Mailing address
55 N Church St Apt 1
Ephrata, PA 17522-2080
Phone (717) 721-3890
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018017590003 | Medicaid | PA |
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 |
|---|---|---|---|
| PS 008371L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295747079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 N CHURCH ST APT 1",
"city": "EPHRATA",
"state": "PA",
"postal_code": "175222080",
"telephone_number": "717-721-3890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 VIEWRIDGE AVE STE 230",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231680",
"telephone_number": "800-257-8715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THVEDT",
"first_name": "JOHN",
"middle_name": "E.",
"credential": "EDD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS 008371L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018017590003",
"state": "PA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.