Active NPI
Charles Odipo, ED. D
- Cognitive & Behavioral Psychologist
- Sacramento, CA
National Provider Identifier
1568610822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- PSY19345
- Practice address
- 3067 Freeport Blvd
Sacramento, CA 95818-4347 - Phone
- (916) 217-7529
- Fax
- (916) 229-0689
- NPI assigned
- Aug 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY19345 | CA | Primary |
Addresses
Primary practice location
3067 Freeport Blvd
Sacramento, CA 95818-4347
Mailing address
3067 Freeport Blvd
Sacramento, CA 95818-4347
Phone (916) 217-7529
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 |
|---|---|---|---|
| PSY19345 | CA | MD | Cognitive & Behavioral Psychologist |
| 19345 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219881600000",
"number": "1568610822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3067 FREEPORT BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958184347",
"telephone_number": "916-217-7529",
"fax_number": "916-229-0689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3067 FREEPORT BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958184347",
"telephone_number": "916-217-7529",
"fax_number": "916-229-0689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODIPO",
"first_name": "CHARLES",
"credential": "ED. D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-28",
"last_updated": "2008-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "CA",
"license": "PSY19345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.