Active NPI
Charlotte Distefano, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1679096101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY29280
- Practice address
- 760 Westwood PLZ # 48-240
Los Angeles, CA 90095-8353 - Phone
- (310) 825-0586
- NPI assigned
- Jul 17, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | PSY29280 | CA | |
| Clinical Psychologist | 103TC0700X | PSY29280 | CA | Primary |
Addresses
Primary practice location
760 Westwood PLZ # 48-240
Los Angeles, CA 90095-8353
Mailing address
760 Westwood PLZ # A7-461
Los Angeles, CA 90095-8353
Phone (310) 825-8892
Other names 1
- Charlotte Mucchetti
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 |
|---|---|---|---|
| PSY29280 | CA | MD | Intellectual & Developmental Disabilities Psychologist |
| 29280 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500249600000",
"number": "1679096101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 WESTWOOD PLZ # A7-461",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958353",
"telephone_number": "310-825-8892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 WESTWOOD PLZ # 48-240",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958353",
"telephone_number": "310-825-0586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTEFANO",
"first_name": "CHARLOTTE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-17",
"last_updated": "2017-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "CA",
"license": "PSY29280",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY29280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CHARLOTTE",
"last_name": "MUCCHETTI",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.