Active NPI
Timothy J. Verna, PSY.D
- Psychologist
- Lake Forest, CA
National Provider Identifier
1689083222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY26397
- Practice address
- 25535 Fallenwood
Lake Forest, CA 92630-6458 - Phone
- (714) 745-6380
- NPI assigned
- Aug 7, 2014
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY26397 | CA | Primary |
Addresses
Primary practice location
25535 Fallenwood
Lake Forest, CA 92630-6458
Mailing address
25535 Fallenwood
Lake Forest, CA 92630-6458
Phone (714) 745-6380
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26397 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522800000000",
"number": "1689083222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25535 FALLENWOOD",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926306458",
"telephone_number": "714-745-6380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25535 FALLENWOOD",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926306458",
"telephone_number": "714-745-6380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERNA",
"first_name": "TIMOTHY",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-07",
"last_updated": "2018-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY26397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.