Active NPI
Marie Christine Matheson, PHD
- Clinical Psychologist
- Malibu, CA
National Provider Identifier
1467400762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY16907
- Practice address
- 28809 Boniface Dr
Malibu, CA 90265-4205 - Phone
- (310) 317-1233
- Fax
- (310) 457-5055
- NPI assigned
- May 5, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY16907 | CA | Primary |
| Clinical Neuropsychologist | 103G00000X | PSY16907 | CA |
Addresses
Primary practice location
28809 Boniface Dr
Malibu, CA 90265-4205
Mailing address
11901 Santa Monica Blvd
Ste 504
Los Angeles, CA 90025-2767
Phone (310) 317-1233
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 |
|---|---|---|---|---|
| I20040618001376 | CA | Practitioner - Clinical Psychologist | 6901881531 | Practice locations: Malibu, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16907 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1467400762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11901 SANTA MONICA BLVD",
"address_2": "STE 504",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900252767",
"telephone_number": "310-317-1233",
"fax_number": "310-457-5055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28809 BONIFACE DR",
"city": "MALIBU",
"state": "CA",
"postal_code": "902654205",
"telephone_number": "310-317-1233",
"fax_number": "310-457-5055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHESON",
"first_name": "MARIE",
"middle_name": "CHRISTINE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-05",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY16907",
"primary": true
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY16907",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malibu, CA
- Maribel Mancillas
- Arthur Jay Margulies, JD, CADC-I
- Marriage and Family Research Institute
- Stephanie Rea Ann Martinez, M.A., AMFT
- Mashae Williams LLC
- Suzanne Elizabeth Matteson
- Maugeri and Chinn, a Chiropractic Corporation (Malibu Chiropractic Center)
- Ronald Charles Maugeri, D.C.
- Hussam Yaser Mawari, MD
- Carol Ann MC Cabe, B.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.