Active NPI
Carlos Alberto Protzel, LCSW, PSYD
- Clinical Psychologist
- Marina del Rey, CA
National Provider Identifier
1447580105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 24612
- Practice address
- 333 Washington Blvd #674
Marina del Rey, CA 90292 - Phone
- (323) 454-3041
- Fax
- (888) 975-0227
- NPI assigned
- Dec 31, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 26028 | CA | |
| Clinical Psychologist | 103TC0700X | PSY 24612 | CA | Primary |
Addresses
Primary practice location
333 Washington Blvd #674
Marina del Rey, CA 90292
Mailing address
333 Washington Blvd #674
Marina del Rey, CA 90292
Phone (323) 454-3041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 24612 | CA | MD | Clinical Psychologist |
| 26028 | CA | MD | Clinical Social Worker |
| 24612 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1447580105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 WASHINGTON BLVD #674",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "90292",
"telephone_number": "323-454-3041",
"fax_number": "888-975-0227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 WASHINGTON BLVD #674",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "90292",
"telephone_number": "323-454-3041",
"fax_number": "888-975-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROTZEL",
"first_name": "CARLOS",
"middle_name": "ALBERTO",
"name_prefix": "Dr.",
"credential": "LCSW, PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-31",
"last_updated": "2020-11-16",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "26028",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 24612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina del Rey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.