Active NPI
Patrice Ruth Wolters, PHD
- Clinical Psychologist
- Capitola, CA
National Provider Identifier
1326298746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8100
- Practice address
- 519 Capitola Ave Ste B
Capitola, CA 95010-2794 - Phone
- (831) 457-7775
- NPI assigned
- Sep 22, 2008
- Last updated
- Sep 22, 2008
- 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 | PSY8100 | CA | Primary |
Addresses
Primary practice location
519 Capitola Ave Ste B
Capitola, CA 95010-2794
Mailing address
519 Capitola Ave Ste B
Capitola, CA 95010-2794
Phone (831) 457-7775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 21, 2024 through Nov 21, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY8100 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1326298746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "519 CAPITOLA AVE STE B",
"city": "CAPITOLA",
"state": "CA",
"postal_code": "950102794",
"telephone_number": "831-457-7775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 CAPITOLA AVE STE B",
"city": "CAPITOLA",
"state": "CA",
"postal_code": "950102794",
"telephone_number": "831-457-7775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLTERS",
"first_name": "PATRICE",
"middle_name": "RUTH",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-22",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Capitola, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.