Bridget Mary Wieckowski, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY31996 Issued in CA

Practice address

1101 S Winchester Blvd Ste J205
San Jose, CA 95128-3918

Phone

(408) 680-4114

NPI assigned

Aug 11, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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.

• Blossoming Minds Psychological Services PC

  • Psychologist
  • Roseville, CA
  • NPI 1255298535
  NPD Authorized official
• Shereen Mohsen Psychology Corp.

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1205528981

  Psychologist

  NPD

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1366818577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 S WINCHESTER BLVD STE J205",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951283918",
            "telephone_number": "408-680-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S WINCHESTER BLVD STE J205",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951283918",
            "telephone_number": "408-680-4114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2275 Arlington Dr",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945781132",
            "country_code": "US",
            "telephone_number": "510-317-1444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIECKOWSKI",
        "first_name": "BRIDGET",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY31996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Neema Wibisono, PA-C
• Zoila Wichmann, LMFT
• Katherine Wickham
• Carrie Lee Wickware, CDE
• Dennis Jordan Widman, DDS
• Tatum Catherine Wieder
• Caleb Hart Wiegman
• Kenneth Wiener, O.D.
• Chilla Wiersema, PHARMD
• Nicole P. Wiesen, LMFT

• Psychologist in San Jose, CA
• Providers in San Jose, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.