Active NPI
Mary Holtom, PSYCHOLOGIST
- Clinical Psychologist
- Long Beach, CA
National Provider Identifier
1336788678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31334
- Practice address
- 4300 Long Beach Blvd Ste 340
Long Beach, CA 90807-2017 - Phone
- (562) 294-4024
- NPI assigned
- Jan 3, 2020
- Sex
- Female
- 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 Psychologist | 103TC0700X | PSY31334 | CA | Primary |
Addresses
Primary practice location
4300 Long Beach Blvd Ste 340
Long Beach, CA 90807-2017
Mailing address
6324 Southwind Dr
Whittier, CA 90601-3843
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 |
|---|---|---|---|
| PSY31334 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1336788678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6324 SOUTHWIND DR",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906013843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 LONG BEACH BLVD STE 340",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908072017",
"telephone_number": "562-294-4024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLTOM",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-03",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.