Individual provider Active NPI

Josette Marie Ciolino, PSY. D.

  • Psychologist
  • San Pedro, CA
National Provider Identifier
1720045248
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY18122 Issued in CA
Practice address
222 W 6TH St # 459
San Pedro, CA 90731-3316
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY18122 CA Primary

Addresses

Primary practice location

222 W 6TH St # 459
San Pedro, CA 90731-3316

Mailing address

222 W 6TH St Ste 400
San Pedro, CA 90731-3345
Phone (310) 971-1868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050818000692 CA Practitioner - Clinical Psychologist 4587694518 Practice locations: San Pedro, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

222 W 6TH St
Suite 459
San Pedro, CA 90731-3316
Phone (310) 707-2585

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY18122CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Psychiatric Medical Group Past Accepting new patients
Salt Marriage and Family Therapy Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1720045248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W 6TH ST STE 400",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313345",
            "telephone_number": "310-971-1868",
            "fax_number": "310-707-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W 6TH ST # 459",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIOLINO",
        "first_name": "JOSETTE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY18122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

Verify at the official NPI Registry.