Individual provider Active NPI

Seda Gragossian, PHD

  • Addiction (Substance Use Disorder) Psychologist
  • San Diego, CA
National Provider Identifier
1548460835
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
License
24901 Issued in CA
Practice address
5935 Cornerstone CT W
Suite 125
San Diego, CA 92121-3737
Phone
(858) 205-2490
NPI assigned
Jul 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Psychologist 103TA0400X 24901 CA Primary

Addresses

Primary practice location

5935 Cornerstone CT W
Suite 125
San Diego, CA 92121-3737

Mailing address

5935 Cornerstone CT W
Suite 125
San Diego, CA 92121-3737
Phone (858) 205-2490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 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
I20161109002614 CA Practitioner - Clinical Psychologist 0345529699 Reassigns benefits to 1 organization
I20231016001610 FL Practitioner - Clinical Psychologist 0345529699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

9262 Rialto LN
Naples, FL 34119-2018
Phone (858) 205-2490

9920 Pacific Heights Blvd
Suite 150
San Diego, CA 92121-4361
Phone (858) 205-2490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Talk Therapy Psychology Center, Corp. CurrentSince Sep 5, 2016 Accepting new patients

Locations

9920 Pacific Heights Blvd
Ste 150
San Diego, CA 92121
Phone (855) 559-7433

5935 Cornerstone Ct W
Ste 125
San Diego, CA 92121
Phone (858) 205-2490

Organizations & group practices 1

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": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1548460835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5935 CORNERSTONE CT W",
            "address_2": "SUITE 125",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213737",
            "telephone_number": "858-205-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5935 CORNERSTONE CT W",
            "address_2": "SUITE 125",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213737",
            "telephone_number": "858-205-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAGOSSIAN",
        "first_name": "SEDA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "24901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.