Active NPI
Deborah Nazarian, PH.D.
- Clinical Psychologist
- Palo Alto, CA
National Provider Identifier
1619252061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 24414
- Practice address
- 665 Lytton Ave
Suite 1
Palo Alto, CA 94301-1335 - Phone
- (415) 713-6831
- NPI assigned
- Oct 17, 2011
- 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 | 24414 | CA | Primary |
Addresses
Primary practice location
665 Lytton Ave
Suite 1
Palo Alto, CA 94301-1335
Mailing address
PO Box 5235
San Mateo, CA 94402-0235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 3, 2023 through Feb 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24414 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1619252061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5235",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944020235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 LYTTON AVE",
"address_2": "SUITE 1",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943011335",
"telephone_number": "415-713-6831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAZARIAN",
"first_name": "DEBORAH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-17",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "24414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; 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.