Adeline Bortz

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

34667 Issued in CA

Practice address

845 El Camino Real
Menlo Park, CA 94025-4807

Phone

(650) 762-8352

NPI assigned

Jan 2, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 2, 2024 through Jan 2, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Pacific Anxiety Group

  • Cognitive & Behavioral Psychologist
  • Menlo Park, CA
  • NPI 1144562828
  NPD (past)

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

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1467222307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 EL CAMINO REAL APT 314",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940632644",
            "telephone_number": "970-531-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 EL CAMINO REAL",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254807",
            "telephone_number": "650-762-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORTZ",
        "first_name": "ADELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-02",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "34667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Michele Blue, BSN
• Jessica Bocca, LCSW
• David N. Bogart, P.T.
• Jodie L Bogomilsky, M.D.
• Samantha Bona
• Jeane Bosch, PHD
• Nicholas T Bott, PSY.D.
• Melissa Christina Bourbonniere, OTRL
• Monica Bowditch, L.AC.
• Richard Kourtney Bowes, M.D.

• Clinical Child & Adolescent Psychologist in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Clinical Child & Adolescent Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; 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.

Verify at the official NPI Registry.