Active NPI
Sharon Lewis-Bultsma, PSY.D.
- Clinical Psychologist
- Fullerton, CA
National Provider Identifier
1578031399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19732
- Practice address
- 1012 E Chapman Ave
Fullerton, CA 92831-3812 - Phone
- (714) 931-2963
- NPI assigned
- Nov 9, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19732 | CA | Primary |
Addresses
Primary practice location
1012 E Chapman Ave
Fullerton, CA 92831-3812
Mailing address
1012 E Chapman Ave
Fullerton, CA 92831-3812
Phone (714) 931-2963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 25, 2018 through Nov 25, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19732 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541721600000",
"number": "1578031399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 E CHAPMAN AVE",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928313812",
"telephone_number": "714-931-2963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 E CHAPMAN AVE",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928313812",
"telephone_number": "714-931-2963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS-BULTSMA",
"first_name": "SHARON",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-09",
"last_updated": "2018-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.