Individual provider Active NPI

David Godot, PSY.D.

  • Clinical Psychologist
  • Long Beach, CA
National Provider Identifier
1679941256
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY27572 Issued in CA
Practice address
3950 Long Beach Blvd
Ste 101
Long Beach, CA 90807-5410
Phone
(562) 684-1300
Fax
(562) 684-1301
NPI assigned
Sep 12, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY27572 CA Primary

Addresses

Primary practice location

3950 Long Beach Blvd
Ste 101
Long Beach, CA 90807-5410

Mailing address

3950 Long Beach Blvd
Ste 101
Long Beach, CA 90807-5410
Phone (562) 684-1305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200603001240 CA Practitioner - Clinical Psychologist 1254630551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psych Lab Psychology IncGroup PAC ID 4880015791, 2 clinicians

Practice addresses (Care Compare)

3950 Long Beach Blvd
Suite 101
Long Beach, CA 90807-5410
Phone (562) 684-1305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY27572CAMDClinical Psychologist

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1679941256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 LONG BEACH BLVD",
            "address_2": "STE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075410",
            "telephone_number": "562-684-1305",
            "fax_number": "562-684-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 LONG BEACH BLVD",
            "address_2": "STE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075410",
            "telephone_number": "562-684-1300",
            "fax_number": "562-684-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODOT",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-12",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.