Active NPI
Donald Jaskulske
- Clinical Psychologist
- Northridge, CA
National Provider Identifier
1679600266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 20848
- Practice address
- 9650 Zelzah Ave
Northridge, CA 91325-2003 - Phone
- (818) 993-9311
- NPI assigned
- Feb 28, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 20848 | CA | Primary |
Addresses
Primary practice location
9650 Zelzah Ave
Northridge, CA 91325-2003
Mailing address
9650 Zelzah Ave
Northridge, CA 91325-2003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130301000370 | VA | Practitioner - Clinical Psychologist | 4486809142 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 20848 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loudoun Psychological Services, LLC | Current | Accepting new patients | |
| County of Loudoun, Virginia | Past | Accepting new patients |
Locations
217 S King St
Leesburg, VA 20175
Phone (703) 297-4368
107 Carpenter Dr
Ste 110
Sterling, VA 20164
Phone (703) 297-4368
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- State or Local Public Health Clinic/Center
- Leesburg, VA
- NPI 1588353569
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679600266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9650 ZELZAH AVE",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913252003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9650 ZELZAH AVE",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913252003",
"telephone_number": "818-993-9311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JASKULSKE",
"first_name": "DONALD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 20848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northridge, 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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.