Active NPI
Kelly Christine O'Neill
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1316345382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY17350
- Practice address
- 16767 Bernardo Center Dr. L1#270289
San Diego, CA 92198 - Phone
- (888) 748-4057
- NPI assigned
- Dec 8, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY17350 | CA | Primary |
Addresses
Primary practice location
16767 Bernardo Center Dr. L1#270289
San Diego, CA 92198
Mailing address
PO Box 1477
Laguna Beach, CA 92652-1477
Phone (949) 290-6505
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 |
|---|---|---|---|
| PSY17350 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417996800000",
"number": "1316345382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1477",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926521477",
"telephone_number": "949-290-6505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16767 BERNARDO CENTER DR. L1#270289",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92198",
"telephone_number": "888-748-4057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'NEILL",
"first_name": "KELLY",
"middle_name": "CHRISTINE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-08",
"last_updated": "2014-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY17350",
"primary": true
}
],
"identifiers": [],
"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 Dec 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.