Tiffani Ledel Poulsen, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY22864 Issued in CA

Practice address

316 S Humboldt St
San Mateo, CA 94401-3338

Phone

(650) 393-3134

NPI assigned

Jan 13, 2013

Last updated

Jul 12, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Tiffani Ledel Edmunds Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wood Glen Hall, Inc.

  • Assisted Living Facility
  • Santa Barbara, CA
  • NPI 1992107205
  NPD (past)

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

{
    "created_epoch": "1358035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499817600000",
    "number": "1487991261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 S HUMBOLDT ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013338",
            "telephone_number": "650-393-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 S HUMBOLDT ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013338",
            "telephone_number": "650-393-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "TIFFANI",
        "middle_name": "LEDEL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-13",
        "last_updated": "2017-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY22864",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANI",
            "last_name": "EDMUNDS",
            "middle_name": "LEDEL",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marina Post, MD
• Deborah Postal, D.D.S.
• Manasa Potharaju
• Christian Potter, PPS
• Michelle Busch Potter, LMFT
• Angela Powell-Bulutoglu, LMFT
• Diana Crooks Powers, D.D.S.
• Thomas Jefferson Powers VI, DDS
• Milly Poz
• PPSS Health

• Clinical Psychologist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.