Active NPI
Suzanne Cheryl Wilson, PSYD
- Psychologist
- Newport Beach, CA
National Provider Identifier
1295981694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 3990 Westerly PL
Suite 160
Newport Beach, CA 92660-2310 - Phone
- (949) 922-4594
- NPI assigned
- Aug 18, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
3990 Westerly PL
Suite 160
Newport Beach, CA 92660-2310
Mailing address
3990 Westerly PL
Suite 160
Newport Beach, CA 92660-2310
Phone (949) 922-4594
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00355940 | Other | NY | AGENCY MEDICAID ID |
| 1285628552 | Other | NY | AGENCY NPI |
| WVE061 | Other | NY | AGENCY MEDICARE ID |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362355200000",
"number": "1295981694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3990 WESTERLY PL",
"address_2": "SUITE 160",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602310",
"telephone_number": "949-922-4594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 WESTERLY PL",
"address_2": "SUITE 160",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602310",
"telephone_number": "949-922-4594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SUZANNE",
"middle_name": "CHERYL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-18",
"last_updated": "2013-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY MEDICAID ID",
"identifier": "00355940",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY NPI",
"identifier": "1285628552",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY MEDICARE ID",
"identifier": "WVE061",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.