Active NPI
Caroll Ann Berndt, PSY.D., J.D.
- Clinical Psychologist
- Walla Walla, WA
National Provider Identifier
1700181773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-004131
- Practice address
- 77 Wainwright Dr
Building 69
Walla Walla, WA 99362-3975 - Phone
- (509) 525-5200
- NPI assigned
- Jan 21, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071-004131 | IL | Primary |
| Clinical Psychologist | 103TC0700X | 3215 | CO |
Addresses
Primary practice location
77 Wainwright Dr
Building 69
Walla Walla, WA 99362-3975
Mailing address
278 NW Laurella LN
College Place, WA 99324-1265
Phone (970) 319-5564
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
- Credentials
- Juris Doctor
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3215 | CO | MD | Clinical Psychologist |
| 071-004131 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonathan M. Wainwright Memorial VA Medical Center | Past | Accepting new patients |
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.
-
- Clinical Social Worker
- Walla Walla, WA
- NPI 1306933650
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1700181773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "278 NW LAURELLA LN",
"city": "COLLEGE PLACE",
"state": "WA",
"postal_code": "993241265",
"telephone_number": "970-319-5564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 WAINWRIGHT DR",
"address_2": "BUILDING 69",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993623975",
"telephone_number": "509-525-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNDT",
"first_name": "CAROLL",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSY.D., J.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-21",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-004131",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3215",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.