Active NPI
Larry M. Bencich, PH.D.
- Clinical Psychologist
- Yountville, CA
National Provider Identifier
1578700381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 5730
- Practice address
- 220 California Dr
Yountville, CA 94599-1412 - Phone
- (707) 944-4771
- Fax
- (707) 948-2530
- NPI assigned
- Jan 15, 2009
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 5730 | CA | Primary |
Addresses
Primary practice location
220 California Dr
Yountville, CA 94599-1412
Mailing address
220 California Dr
Yountville, CA 94599-1412
Phone (707) 944-4771
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY 5730 | Other | CA | PSYCHOLOGY LICENSE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 5730 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Veterans Home of California | 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 and National Provider Directory roles.
-
- Skilled Nursing Facility
- Yountville, CA
- NPI 1104811751
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231977600000",
"number": "1578700381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 CALIFORNIA DR",
"city": "YOUNTVILLE",
"state": "CA",
"postal_code": "945991412",
"telephone_number": "707-944-4771",
"fax_number": "707-948-2530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 CALIFORNIA DR",
"city": "YOUNTVILLE",
"state": "CA",
"postal_code": "945991412",
"telephone_number": "707-944-4771",
"fax_number": "707-948-2530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENCICH",
"first_name": "LARRY",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-15",
"last_updated": "2009-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 5730",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "PSY 5730",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yountville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.