Active NPI
Brenda Ira Poll, PH.D., PSY.D.
- Clinical Psychologist
- Irvine, CA
National Provider Identifier
1609088012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10179
- Practice address
- 111 Pacifica
Suite 270
Irvine, CA 92618-3310 - Phone
- (949) 341-0393
- Fax
- (949) 715-9029
- NPI assigned
- May 6, 2007
- 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 | PSY10179 | CA | Primary |
Addresses
Primary practice location
111 Pacifica
Suite 270
Irvine, CA 92618-3310
Mailing address
635 Fontana Way
Laguna Beach, CA 92651-4053
Phone (949) 715-9019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY10179 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609088012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 FONTANA WAY",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926514053",
"telephone_number": "949-715-9019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 PACIFICA",
"address_2": "SUITE 270",
"city": "IRVINE",
"state": "CA",
"postal_code": "926183310",
"telephone_number": "949-341-0393",
"fax_number": "949-715-9029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLL",
"first_name": "BRENDA",
"middle_name": "IRA",
"name_prefix": "Dr.",
"credential": "PH.D., PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY10179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.