Active NPI
Judith Ruth Profant, PHD, CBSM
- Clinical Psychologist
- Newport Beach, CA
National Provider Identifier
1346485810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20784
- Practice address
- 5001 Birch St
Newport Beach, CA 92660-2116 - Phone
- (949) 302-2020
- NPI assigned
- Dec 11, 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 | PSY20784 | CA | Primary |
Addresses
Primary practice location
5001 Birch St
Newport Beach, CA 92660-2116
Mailing address
PO Box 727
Corona del Mar, CA 92625-0727
Phone (949) 302-2020
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20784 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228953600000",
"number": "1346485810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 727",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926250727",
"telephone_number": "949-302-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5001 BIRCH ST",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602116",
"telephone_number": "949-302-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROFANT",
"first_name": "JUDITH",
"middle_name": "RUTH",
"credential": "PHD, CBSM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-11",
"last_updated": "2008-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
- Rayeonne Pritchett
- Private Physicians Medical Associates
- Private Physicians Medical Associates
- August Benjamin Privratsky Jr., PT, CP
- Cheryl A. Procaccini
- Professional Partners Inc (Westcliff Compounding Pharmacy)
- Rosalie Ann Proffer, MA LMFT MARRIAGE FAM
- Prohealth Partners a Medical Group Inc
- Prosperity Wellness Inc
- Christine Marie Prosser, MFT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.