Active NPI
Amy B Percosky, PH.D.
- Clinical Psychologist
- Atascadero, CA
National Provider Identifier
1588809768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 28344
- Practice address
- 10333 El Camino Real
Atascadero, CA 93422-5808 - Phone
- (805) 468-2000
- Fax
- (805) 466-6011
- NPI assigned
- Dec 2, 2008
- Last updated
- Jul 28, 2016
- 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 | 28344 | CA | Primary |
Addresses
Primary practice location
10333 El Camino Real
Atascadero, CA 93422-5808
Mailing address
1600 9TH St
Room 150
Sacramento, CA 95814-6414
Phone (916) 651-9476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A777971 | Other | CA | MEDICARE ID-TYPE UNSPECIFIED |
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 |
|---|---|---|---|
| 28344 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1588809768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 9TH ST",
"address_2": "ROOM 150",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958146414",
"telephone_number": "916-651-9476",
"fax_number": "916-651-8908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10333 EL CAMINO REAL",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225808",
"telephone_number": "805-468-2000",
"fax_number": "805-466-6011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERCOSKY",
"first_name": "AMY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-02",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "28344",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID-TYPE UNSPECIFIED",
"identifier": "00A777971",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.