Active NPI
Lori Rice Pandolfo, PSY.D.
- Clinical Psychologist
- Santa Rosa, CA
National Provider Identifier
1386168425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY22049
- Practice address
- 320 10TH St Ste 301
Santa Rosa, CA 95401 - Phone
- (707) 800-9850
- NPI assigned
- Jul 31, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY22049 | CA | Primary |
Addresses
Primary practice location
320 10TH St Ste 301
Santa Rosa, CA 95401
Mailing address
320 10TH St Ste 301
Santa Rosa, CA 95401-5291
Phone (707) 800-9850
Other practice location 1
1049 4th St Ste G
Santa Rosa, CA 95404-4345
Phone (707) 800-9850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180515003120 | CA | Practitioner - Clinical Psychologist | 3971867102 | Practice locations: Santa Rosa, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY22049 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1386168425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 10TH ST STE 301",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954015291",
"telephone_number": "707-800-9850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 10TH ST STE 301",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95401",
"telephone_number": "707-800-9850"
}
],
"practiceLocations": [
{
"address_1": "1049 4th St Ste G",
"address_purpose": "LOCATION",
"city": "Santa Rosa",
"state": "CA",
"postal_code": "954044345",
"country_code": "US",
"telephone_number": "707-800-9850",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PANDOLFO",
"first_name": "LORI",
"middle_name": "RICE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-31",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY22049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.