Active NPI
Heidar A. Modaresi, PHD
- Clinical Psychologist
- Rock Hill, SC
National Provider Identifier
1619920980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0575
- Practice address
- 3060 Wimbledon LN
Rock Hill, SC 29732-9249 - Phone
- (803) 366-9791
- Fax
- (803) 753-9522
- NPI assigned
- May 18, 2006
- 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 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1973 | NC | |
| Mental Health Counselor | 101YM0800X | 0575 | SC | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 0575 | SC | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1973 | NC | |
| Clinical Psychologist | 103TC0700X | 0575 | SC | Primary |
| Clinical Psychologist | 103TC0700X | 1973 | NC | |
| Psychologist | 103T00000X | 0575 | SC | |
| Psychologist | 103T00000X | 1973 | NC |
Addresses
Primary practice location
3060 Wimbledon LN
Rock Hill, SC 29732-9249
Mailing address
3060 Wimbledon LN
Rock Hill, SC 29732-9249
Phone (803) 366-9791
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS0221 | Medicaid | SC |
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 |
|---|---|---|---|
| 0575 | SC | MD | Clinical Psychologist |
| 1973 | NC | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1619920980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3060 WIMBLEDON LN",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297329249",
"telephone_number": "803-366-9791",
"fax_number": "803-753-9522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3060 WIMBLEDON LN",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297329249",
"telephone_number": "803-366-9791",
"fax_number": "803-753-9522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODARESI",
"first_name": "HEIDAR",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "1973",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "SC",
"license": "0575",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "SC",
"license": "0575",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "1973",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "0575",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1973",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "SC",
"license": "0575",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1973",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS0221",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
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- Winona P. Mocherman, CRNA
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- Jennifer Lynne Mokris, D.M.D.
- Molly Coggins (Counseling for Growth Services)
- Monica Revels Counseling LLC
- Kacie Bragg Montgomery, OTR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.