Active NPI
Kathlyn Clementelli, PH.D
- Clinical Psychologist
- Campbell, CA
National Provider Identifier
1326397464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 28217
- Practice address
- 3425 S Bascom Ave Ste 250
Campbell, CA 95008-7321 - Phone
- (408) 204-8518
- NPI assigned
- Sep 5, 2012
- 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 | 28217 | CA | Primary |
Addresses
Primary practice location
3425 S Bascom Ave Ste 250
Campbell, CA 95008-7321
Mailing address
3425 S Bascom Ave Ste 250
Campbell, CA 95008-7321
Phone (408) 204-8518
Other names 1
- Dr. Kathlyn Clementelli
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 29, 2020 through May 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28217 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1326397464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3425 S BASCOM AVE STE 250",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950087321",
"telephone_number": "408-204-8518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3425 S BASCOM AVE STE 250",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950087321",
"telephone_number": "408-204-8518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMENTELLI",
"first_name": "KATHLYN",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-05",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "28217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHLYN",
"last_name": "CLEMENTELLI",
"prefix": "DR.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Campbell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.