Wayne Allen Bardwell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16112 Issued in CA

Practice address

1901 1St Ave Ste 212
San Diego, CA 92101-2382

Phone

(619) 356-0138

NPI assigned

Jan 5, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2014 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1366420630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 KETTNER BLVD UNIT 1101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013459",
            "telephone_number": "619-356-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE STE 212",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012382",
            "telephone_number": "619-356-0138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3252 Holiday Ct Ste 109",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371807",
            "country_code": "US",
            "telephone_number": "619-356-0138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARDWELL",
        "first_name": "WAYNE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Barden
• Teresa Bardenhagen, MS, RD, CDE
• Marguerite Bitonti Barder, LCSW
• Brooke Elizabeth Bardin, MSW
• Moran Bardugo
• Anna K Bareiss, MD
• Ayeh Barekat, PHARMD
• Patricia Barela, MS, CCC-SLP
• Ryan Anthony Barenchi, MD
• Richard Martin Bareno

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• 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; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.