Active NPI
Benjamin Wilson, PSY.D.
- Clinical Child & Adolescent Psychologist
- Riverside, CA
National Provider Identifier
1295990992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PSY25427
- Practice address
- 3125 Myers St Ste 2
Riverside, CA 92503-5527 - Phone
- (951) 358-4840
- Fax
- (951) 358-4848
- NPI assigned
- Jul 22, 2008
- 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 Child & Adolescent Psychologist | 103TC2200X | PSY25427 | CA | Primary |
Addresses
Primary practice location
3125 Myers St Ste 2
Riverside, CA 92503-5527
Mailing address
9890 County Farm Rd
Riverside, CA 92503-3505
Phone (951) 358-4840
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25427 | CA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1295990992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9890 COUNTY FARM RD",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925033505",
"telephone_number": "951-358-4840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3125 MYERS ST STE 2",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035527",
"telephone_number": "951-358-4840",
"fax_number": "951-358-4848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-22",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY25427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.