Active NPI
Joseph John Nicolosi Jr., PH.D.
- Clinical Psychologist
- Encino, CA
National Provider Identifier
1700165602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY25555
- Practice address
- 17835 Ventura Blvd
Ste # 207
Encino, CA 91316 - Phone
- (818) 609-0147
- NPI assigned
- Aug 9, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY25555 | CA | Primary |
| Clinical Psychologist | 103TC0700X | PSB36547 | CA |
Addresses
Primary practice location
17835 Ventura Blvd
Ste # 207
Encino, CA 91316
Mailing address
17835 Ventura Blvd
Ste # 207
Encino, CA 91316
Phone (818) 609-0147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 4, 2018 through Dec 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB36547 | CA | MD | Clinical Psychologist |
| PSY25555 | CA | MD | Clinical Psychologist |
| 25555 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517529600000",
"number": "1700165602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17835 VENTURA BLVD",
"address_2": "STE # 207",
"city": "ENCINO",
"state": "CA",
"postal_code": "91316",
"telephone_number": "818-609-0147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17835 VENTURA BLVD",
"address_2": "STE # 207",
"city": "ENCINO",
"state": "CA",
"postal_code": "91316",
"telephone_number": "818-609-0147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLOSI",
"first_name": "JOSEPH",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-09",
"last_updated": "2018-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY25555",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB36547",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.