Individual provider Active NPI

Amanda B Medrano, PSY.D

  • Clinical Psychologist
  • Concord, CA
National Provider Identifier
1578870549
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY26669 Issued in CA
Practice address
2151 Salvio St Ste 301
Concord, CA 94520-6304
Phone
(925) 671-0777
NPI assigned
Sep 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Clinical Psychologist 103TC0700X PSY26669 CA Primary

Addresses

Primary practice location

2151 Salvio St Ste 301
Concord, CA 94520-6304

Mailing address

2191 Kirker Pass Rd
Concord, CA 94521-1629
Phone (925) 671-0777

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PSY26669CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lucent: Perinatal and Infant Psychological Services PC Clinical Current Accepting new patients
We Care Services for Children CurrentSince May 21, 2023 Accepting new patients
Mood Clinical, P. C. PastSince Nov 1, 2021 Accepting new patients
Pasadena Clinical Group, a Psychology Corporation Psychologist Past Accepting new patients
Glenn Medical Center, LLC PastSince Nov 1, 2021 Accepting new patients
We Care Services for Children PastSince May 21, 2023 Accepting new patients

Locations

2151 Salvio St
Ste 301
Concord, CA 94520
Phone (925) 671-0777

Organizations & group practices 6

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": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1578870549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2191 KIRKER PASS RD",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945211629",
            "telephone_number": "925-671-0777",
            "fax_number": "925-681-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 SALVIO ST STE 301",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945206304",
            "telephone_number": "925-671-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDRANO",
        "first_name": "AMANDA",
        "middle_name": "B",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-10",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY26669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.