Active NPI
Timothy Scott Spicer, PSY.D.
- Psychologist
- Riverside, CA
National Provider Identifier
1306284104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 769 W Blaine St
Suite B
Riverside, CA 92507-3970 - Phone
- (646) 346-0918
- NPI assigned
- Jun 13, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
769 W Blaine St
Suite B
Riverside, CA 92507-3970
Mailing address
PO Box 17640
Anaheim, CA 92817-7640
Phone (646) 346-0918
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 |
|---|---|---|---|
| 29755 | CA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463702400000",
"number": "1306284104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 17640",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928177640",
"telephone_number": "646-346-0918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "769 W BLAINE ST",
"address_2": "SUITE B",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925073970",
"telephone_number": "646-346-0918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPICER",
"first_name": "TIMOTHY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-13",
"last_updated": "2016-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"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 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.