Active NPI
Jacob Serry, PHD
- Psychologist
- Los Angeles, CA
National Provider Identifier
1386009553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 60837656
- Practice address
- 4900 Cleland Ave
Los Angeles, CA 90042-3115 - Phone
- (818) 640-5652
- NPI assigned
- Dec 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 60837656 | WA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 60837656 | WA | |
| Clinical Psychologist | 103TC0700X | 60837656 | WA |
Addresses
Primary practice location
4900 Cleland Ave
Los Angeles, CA 90042-3115
Mailing address
4900 Cleland Ave
Los Angeles, CA 90042-3115
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 |
|---|---|---|---|
| 60837656 | WA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1386009553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 CLELAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900423115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 CLELAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900423115",
"telephone_number": "818-640-5652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRY",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-15",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "60837656",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "WA",
"license": "60837656",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "60837656",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.