Active NPI
Micaela Thordarson, PHD
- Clinical Psychologist
- Orange, CA
National Provider Identifier
1366811101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29572
- Practice address
- 1120 W la Veta Ave Ste 400
Orange, CA 92868-4243 - Phone
- (714) 509-8262
- Fax
- (714) 509-8266
- NPI assigned
- Sep 23, 2015
- 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 | 29572 | CA | Primary |
Addresses
Primary practice location
1120 W la Veta Ave Ste 400
Orange, CA 92868-4243
Mailing address
1120 W la Veta Ave Ste 400
Orange, CA 92868-4243
Phone (714) 509-8262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2846675 | Medicaid | OH |
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 |
|---|---|---|---|
| 29572 | CA | MD | Clinical Psychologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762732800000",
"number": "1366811101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 W LA VETA AVE STE 400",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684243",
"telephone_number": "714-509-8262",
"fax_number": "714-509-8266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 W LA VETA AVE STE 400",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684243",
"telephone_number": "714-509-8262",
"fax_number": "714-509-8266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORDARSON",
"first_name": "MICAELA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-23",
"last_updated": "2025-11-10",
"certification_date": "2025-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29572",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2846675",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.