Michael Kelly Abbott, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY27701 Issued in CA

Practice address

3300 Tully Rd Ste B6
Modesto, CA 95350-0848

Phone

(209) 585-0555

NPI assigned

Sep 4, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Hope Community Partnership

  • Clinical Social Worker
  • Modesto, CA
  • NPI 1568951663

  Psychologist

  NPD Authorized official
• Hopenet Community Counseling a Licensed Clinical Social Worker Co

  • Clinical Social Worker
  • Modesto, CA
  • NPI 1992453922
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1346498151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9650 ZELZAH AVE",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913252003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 TULLY RD STE B6",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953500848",
            "telephone_number": "209-585-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABBOTT",
        "first_name": "MICHAEL",
        "middle_name": "KELLY",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-04",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY27701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3800 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jayden Abarca
• Humayun Abbas, MD
• Zainab Akmal Abbasi, MBBS
• Cathy Lynn Abbott
• Jeanne Elaine Abbott, LCSW
• Zachary Abbott
• Edith Abdalla
• Anessa Abdisho
• Husam A Abdulnour, M.D
• Angela M Abe, OPT

• All providers in Modesto, CA
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.