Active NPI
Jessica Michelle Simonetti, PH.D.
- Psychologist
- Portland, OR
National Provider Identifier
1508466574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3254
- Practice address
- Portland Psychotherapy Clinic, Research and Training Ce
3700 N Williams Ave
Portland, OR 97227 - Phone
- (503) 281-4852
- Fax
- (503) 575-3711
- NPI assigned
- Oct 29, 2020
- 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 | 3254 | OR | Primary |
Addresses
Primary practice location
Portland Psychotherapy Clinic, Research and Training Ce
3700 N Williams Ave
Portland, OR 97227
Mailing address
Portland Psychotherapy Clinic, Research and Training Ce
3700 N Williams Ave
Portland, OR 97227
Phone (503) 281-4852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 29, 2020 through Oct 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1508466574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PORTLAND PSYCHOTHERAPY CLINIC, RESEARCH AND TRAINING CE",
"address_2": "3700 N WILLIAMS AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97227",
"telephone_number": "503-281-4852",
"fax_number": "503-575-3711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PORTLAND PSYCHOTHERAPY CLINIC, RESEARCH AND TRAINING CE",
"address_2": "3700 N WILLIAMS AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97227",
"telephone_number": "503-281-4852",
"fax_number": "503-575-3711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONETTI",
"first_name": "JESSICA",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-29",
"last_updated": "2020-10-29",
"certification_date": "2020-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "3254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.