Active NPI
Nina Petit de Mange, PSY.D.
- Clinical Psychologist
- Carlsbad, CA
National Provider Identifier
1508025842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26000
- Practice address
- 3150 El Camino Real
Carlsbad, CA 92008-2110 - Phone
- (760) 276-4606
- Fax
- (760) 276-4605
- NPI assigned
- Jun 2, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY26000 | CA | Primary |
Addresses
Primary practice location
3150 El Camino Real
Carlsbad, CA 92008-2110
Mailing address
PO Box 131653
Carlsbad, CA 92013-1653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26000 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1508025842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 131653",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920131653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 EL CAMINO REAL",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920082110",
"telephone_number": "760-276-4606",
"fax_number": "760-276-4605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETIT DE MANGE",
"first_name": "NINA",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-02",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carlsbad, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.