South County Psychological, Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

PSY22415 Issued in CA

Legal business name

SOUTH COUNTY PSYCHOLOGICAL, INC.

Practice address

23832 Rockfield Blvd Ste 130
Lake Forest, CA 92630-2860

Phone

(949) 297-6680

Fax

(949) 861-6321

NPI assigned

Dec 6, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Susan Joy Novak, PHDNPI 1093084162

Title

President/Clinical Psychologist

Phone

(949) 297-6680

Specialties & licenses 2

Addresses

Other names 1

• Susan J. Novak, PhD Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Joy Novak, PHD

  • Clinical Psychologist
  • Lake Forest, CA
  • NPI 1093084162
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1346585908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 130",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302860",
            "telephone_number": "949-297-6680",
            "fax_number": "949-861-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 130",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302860",
            "telephone_number": "949-297-6680",
            "fax_number": "949-861-6321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY PSYCHOLOGICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "PRESIDENT/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "949-297-6680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "PSY22415",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": "PSY22415",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan J. Novak, PhD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Susan J. Novak, PhD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Song W. Jung. DDS. Inc
• Raul Sosa Jr.
• Ashlee Nicole-Morton Sourapas, LM, CPM
• South County Eye Care Optometric Group
• South County Home Health Inc.
• South County Registry
• Southern Orange County Pediatric Associates, Inc.
• Katrina Wingco Spadafore, PA-C
• Martha Spalding, P.T.
• Sparkd Services Corporation

• Adult Mental Health Clinic/Center in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.