Judy Van Der Wende, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY18757 Issued in CA

Practice address

3695 Alamo St
Suite 200
Simi Valley, CA 93063-2188

Phone

(805) 407-4730

Fax

(805) 581-0889

NPI assigned

Dec 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508928383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3695 ALAMO ST",
            "address_2": "SUITE 200",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930632188",
            "telephone_number": "805-407-4730",
            "fax_number": "805-581-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3695 ALAMO ST",
            "address_2": "SUITE 200",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930632188",
            "telephone_number": "805-407-4730",
            "fax_number": "805-581-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER WENDE",
        "first_name": "JUDY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandy C Valladarez, LMFT
• Oscar E Vallejo, OT
• Valley Hospice Services LLC
• Valley Pacific Hospice, Inc.
• Stephen Philip Vampola, MD
• Deborah Van, DDS
• Kenneth Francis Van, OD
• Kevin Van
• Patricia Lynn Vanbuskirk, MA, MFT
• Ann Taylor Vance, PH.D.

• Clinical Psychologist in Simi Valley, CA
• Providers in Simi Valley, 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 8, 2007; 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.

Verify at the official NPI Registry.