Individual provider Active NPI

Patricia Sotolongo, PSYD

  • Clinical Psychologist
  • Provo, UT
National Provider Identifier
1528577590
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
13151124-2501 Issued in UT
Practice address
1300 E Center St
Provo, UT 84606-3554
Phone
(801) 344-4400
NPI assigned
Sep 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 13151124-2501 UT Primary

Addresses

Primary practice location

1300 E Center St
Provo, UT 84606-3554

Mailing address

1300 E Center St
Provo, UT 84606-3554
Phone (801) 344-4400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address psotolongo@utah.gov Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240527000302 UT Practitioner - Clinical Psychologist 0547602229 Reassigns benefits to 1 organization
I20250805001402 CT Practitioner - Clinical Psychologist 0547602229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Neuropsychology LLCGroup PAC ID 3375602931, 16 clinicians

Practice addresses (Care Compare)

609 W Johnson Ave
Suite 104
Cheshire, CT 06410-4506
Phone (203) 272-6007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13151124-2501UTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Utah CurrentSince Apr 2, 2024 Accepting new patients
Northeast Neuropsychology, LLC CurrentSince Sep 1, 2025 Accepting new patients
Advanced Telepsych PLLC PastSince Jan 1, 2024 Accepting new patients

Locations

609 W Johnson Ave
Ste 104
Cheshire, CT 06410
Phone (203) 272-6007

1300 E Center St
Provo, UT 84606
Phone (801) 344-4215

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1528577590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTOLONGO",
        "first_name": "PATRICIA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "13151124-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "psotolongo@utah.gov",
            "affiliation": "N",
            "endpointDescription": "USH email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "all emails from USH",
            "address_1": "1300 E Center St",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846063554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.