Active NPI
Nicole Harris, PSY.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1508608456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY36720
- Practice address
- 3401 Glendale Blvd Ste B
Los Angeles, CA 90039-1814 - Phone
- (310) 318-4218
- NPI assigned
- Jun 11, 2024
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY36720 | CA | Primary |
Addresses
Primary practice location
3401 Glendale Blvd Ste B
Los Angeles, CA 90039-1814
Mailing address
10882 Rose Ave Apt 204
Los Angeles, CA 90034-5352
Phone (310) 318-4218
Other practice location 1
10801 National Blvd Ste 256
Los Angeles, CA 90064-4178
Phone (424) 245-5744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY36720 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778457600000",
"number": "1508608456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10882 ROSE AVE APT 204",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900345352",
"telephone_number": "310-318-4218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 GLENDALE BLVD STE B",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900391814",
"telephone_number": "310-318-4218"
}
],
"practiceLocations": [
{
"address_1": "10801 National Blvd Ste 256",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900644178",
"country_code": "US",
"telephone_number": "424-245-5744",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARRIS",
"first_name": "NICOLE",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-11",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY36720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.