Theodore Ciesinski, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

24868 Issued in CA

Practice address

39180 Liberty St Ste 205
Fremont, CA 94538-2586

Phone

(916) 827-7319

NPI assigned

Jun 26, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Ocean Psychiatry Inc

  • Psychiatry Physician
  • Fremont, CA
  • NPI 1396306338
  NPD
• Ocean Psychological Services, Inc.

  • Behavior Analyst
  • Fremont, CA
  • NPI 1932865029

  Psychologist

  NPD

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1487918231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 LUNALILO HOME ROAD",
            "address_2": "8228",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96825",
            "telephone_number": "916-827-7319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39180 LIBERTY ST STE 205",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382586",
            "telephone_number": "916-827-7319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIESINSKI",
        "first_name": "THEODORE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "HI",
            "license": "1867",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "24868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Ming Tak Chung, PH.D., BCBA-D
• Jeannie Chung, DDS
• Karine Hoyan Chung
• Kathleen Chung, DC
• Tony Chung, DDS
• Robert Cilenti, CPO
• Elizabeth Cisneros
• Lizbeth Cisneros
• City of Fremont
• City of Fremont

• All providers in Fremont, CA
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; 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.

Verify at the official NPI Registry.