Active NPI
David Velleman, PSYD
- Clinical Psychologist
- San Pablo, CA
National Provider Identifier
1427308733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY28603
- Practice address
- 13601 San Pablo Ave
San Pablo, CA 94806-3818 - Phone
- (925) 681-4190
- NPI assigned
- Sep 13, 2012
- Last updated
- Nov 14, 2016
- Sex
- Male
- 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 | PSY28603 | CA | Primary |
Addresses
Primary practice location
13601 San Pablo Ave
San Pablo, CA 94806-3818
Mailing address
13601 San Pablo Ave
San Pablo, CA 94806-3818
Phone (925) 681-4190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 13, 2023 through Nov 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY28603 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1427308733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13601 SAN PABLO AVE",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063818",
"telephone_number": "925-681-4190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13601 SAN PABLO AVE",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063818",
"telephone_number": "925-681-4190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELLEMAN",
"first_name": "DAVID",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-13",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY28603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.