Active NPI
Maija Leena Clarke, PSY.D.
- Clinical Psychologist
- Chico, CA
National Provider Identifier
1689723892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19636
- Practice address
- 630 Salem St
Ste 210
Chico, CA 95928-5556 - Phone
- (530) 519-4177
- Fax
- (530) 345-7677
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- 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 | PSY19636 | CA | Primary |
Addresses
Primary practice location
630 Salem St
Ste 210
Chico, CA 95928-5556
Mailing address
31 Amber Way
Chico, CA 95926-1701
Phone (530) 899-8767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130124000144 | CA | Practitioner - Psychologist Billing Independently | 4688827769 | Practice locations: Chico, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
630 Salem St
Suite 210
Chico, CA 95928-5556
Phone (530) 519-4177
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19636 | CA | MD | Clinical Psychologist |
| 19636 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583712000000",
"number": "1689723892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 AMBER WAY",
"city": "CHICO",
"state": "CA",
"postal_code": "959261701",
"telephone_number": "530-899-8767",
"fax_number": "530-879-3880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 SALEM ST",
"address_2": "STE 210",
"city": "CHICO",
"state": "CA",
"postal_code": "959285556",
"telephone_number": "530-519-4177",
"fax_number": "530-345-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "MAIJA",
"middle_name": "LEENA",
"name_prefix": "Miss",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2020-03-09",
"certification_date": "2020-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.