Active NPI
Michelle Novotny, PSY.D.
- Clinical Psychologist
- Rancho Palos Verdes, CA
National Provider Identifier
1548411291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY32774
- Practice address
- 1922 Peninsula Verde Dr
Rancho Palos Verdes, CA 90275-1053 - Phone
- (303) 882-8879
- NPI assigned
- Sep 30, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3147 | CO | |
| Clinical Psychologist | 103TC0700X | PSY32774 | CA | Primary |
Addresses
Primary practice location
1922 Peninsula Verde Dr
Rancho Palos Verdes, CA 90275-1053
Mailing address
1922 Peninsula Verde Dr
Rancho Palos Verdes, CA 90275-1053
Phone (303) 882-8879
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 |
|---|---|---|---|
| 3147 | CO | MD | Professional Counselor |
| PSY32774 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1548411291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1922 PENINSULA VERDE DR",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902751053",
"telephone_number": "303-882-8879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1922 PENINSULA VERDE DR",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902751053",
"telephone_number": "303-882-8879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVOTNY",
"first_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-30",
"last_updated": "2022-06-27",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3147",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY32774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Palos Verdes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.