Active NPI
John Bruce Todd, PHD
- Psychologist
- Charleston, WV
National Provider Identifier
1730101569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 710
- Practice address
- 1418A Maccorkle Ave SW
Charleston, WV 25303 - Phone
- (304) 348-1288
- Fax
- (304) 348-1262
- NPI assigned
- Jul 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 710 | WV | Primary |
Addresses
Primary practice location
1418A Maccorkle Ave SW
Charleston, WV 25303
Mailing address
PO Box 4009
Charleston, WV 25364-4009
Phone (304) 348-1288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9205058000 | Medicaid | WV |
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
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730101569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4009",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253644009",
"telephone_number": "304-348-1288",
"fax_number": "304-348-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1418A MACCORKLE AVE SW",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "25303",
"telephone_number": "304-348-1288",
"fax_number": "304-348-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TODD",
"first_name": "JOHN",
"middle_name": "BRUCE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "710",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9205058000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.