Active NPI
Marines M Novoa, PSYD-LICENSED
- Clinical Psychologist
- Antioch, CA
National Provider Identifier
1558762716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY29838
- Practice address
- 3454 Hillcrest Ave
Antioch, CA 94531-8238 - Phone
- (925) 777-6300
- NPI assigned
- Sep 8, 2014
- Last updated
- Oct 7, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY29838 | CA | Primary |
Addresses
Primary practice location
3454 Hillcrest Ave
Antioch, CA 94531-8238
Mailing address
3454 Hillcrest Ave
Antioch, CA 94531-8238
Other practice location 1
2121 W Temple St
Building A, B, &C
Los Angeles, CA 90026-4915
Phone (213) 260-7600
Other practice location 2
5776 Stoneridge Mall Rd
Pleasanton, CA 94588-2832
Phone (925) 223-8047
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY29838 | CA | MD | Clinical Psychologist |
| 29838 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Concordia Psychotherapy and Wellness Clinic | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Concord, CA
- NPI 1154933026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570406400000",
"number": "1558762716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3454 HILLCREST AVE",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3454 HILLCREST AVE",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318238",
"telephone_number": "925-777-6300"
}
],
"practiceLocations": [
{
"address_1": "2121 W Temple St",
"address_2": "Building A, B, &C",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900264915",
"country_code": "US",
"telephone_number": "213-260-7600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5776 Stoneridge Mall Rd",
"address_purpose": "LOCATION",
"city": "Pleasanton",
"state": "CA",
"postal_code": "945882832",
"country_code": "US",
"telephone_number": "925-223-8047",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOVOA",
"first_name": "MARINES",
"middle_name": "M",
"credential": "PSYD-LICENSED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-08",
"last_updated": "2019-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY29838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.