Victoria Bustamante Avellaneda, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY 5919 Issued in FL

Practice address

2100 Riviera Ave
Clewiston, FL 33440-9043

Phone

(305) 439-6014

Fax

(863) 902-1512

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Avellaneda Psychological Servivces PA

  • Psychologist
  • Labelle, FL
  • NPI 1215461124
  Medicare reassignment NPD Authorized official
• University of Miami

  • Psychiatry Physician
  • Miami, FL
  • NPI 1437109048
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1740297266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 RIVIERA AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334409043",
            "telephone_number": "305-439-6014",
            "fax_number": "863-902-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 RIVIERA AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334409043",
            "telephone_number": "305-439-6014",
            "fax_number": "863-902-1512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "270 N Bridge St",
            "address_purpose": "LOCATION",
            "city": "LaBelle",
            "state": "FL",
            "postal_code": "339355090",
            "country_code": "US",
            "telephone_number": "305-439-6014",
            "fax_number": "863-902-1512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVELLANEDA",
        "first_name": "VICTORIA",
        "middle_name": "BUSTAMANTE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY 5919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0761575 00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Clewiston, FL
• Providers in Clewiston, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.