Active NPI
Lezlie Scaliatine, PSY.D.
- Psychologist
- Santa Rosa, CA
National Provider Identifier
1487847836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20716
- Practice address
- 1625 Terrace Way
Ste C
Santa Rosa, CA 95404-3035 - Phone
- (510) 206-7917
- NPI assigned
- Aug 20, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20716 | CA | Primary |
Addresses
Primary practice location
1625 Terrace Way
Ste C
Santa Rosa, CA 95404-3035
Mailing address
1625 Terrace Way
Ste C
Santa Rosa, CA 95404-3035
Phone (510) 206-7917
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC03890G | Medicaid | CA |
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 |
|---|---|---|---|---|
| I20120730000706 | CA | Practitioner - Clinical Psychologist | 1355507724 | Practice locations: Santa Rosa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1625 Terrace Way
Suite C
Santa Rosa, CA 95404-3035
Phone (510) 206-7917
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20716 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453161600000",
"number": "1487847836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 TERRACE WAY",
"address_2": "STE C",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043035",
"telephone_number": "510-206-7917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 TERRACE WAY",
"address_2": "STE C",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043035",
"telephone_number": "510-206-7917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCALIATINE",
"first_name": "LEZLIE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-20",
"last_updated": "2016-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "20716",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC03890G",
"state": "CA"
}
],
"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 Jan 19, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.