Active NPI
Derek Wangberg, PSY.D.
- Clinical Psychologist
- Norwalk, CA
National Provider Identifier
1700911666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 21059
- Practice address
- 11401 Bloomfield
Norwalk, CA 90650 - Phone
- (714) 569-5117
- Fax
- (949) 429-7791
- NPI assigned
- Feb 22, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 21059 | CA | Primary |
Addresses
Primary practice location
11401 Bloomfield
Norwalk, CA 90650
Mailing address
11401 Bloomfield
Norwalk, CA 90650
Phone (714) 369-5117
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 |
|---|---|---|---|
| PSY 21059 | CA | MD | Clinical Psychologist |
Interoperability endpoints
- derek.wangberg.1@28394.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1700911666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11401 BLOOMFIELD",
"city": "NORWALK",
"state": "CA",
"postal_code": "90650",
"telephone_number": "714-369-5117",
"fax_number": "949-429-7793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11401 BLOOMFIELD",
"city": "NORWALK",
"state": "CA",
"postal_code": "90650",
"telephone_number": "714-569-5117",
"fax_number": "949-429-7791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANGBERG",
"first_name": "DEREK",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 21059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwalk, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.