Elizabeth Zdradzinski, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY25566 Issued in CA

Practice address

1976 W Rose Street
Stockton, CA 95203

Phone

(209) 425-1645

NPI assigned

Jul 19, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

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.

• Family First Medical Care a Professional Corporation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1689066029
  Medicare reassignment NPD
• Family First Medical Care a Professional Corporation

  • Durable Medical Equipment & Medical Supplies
  • Modesto, CA
  • NPI 1699639070
  NPD

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1760737241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1976 W ROSE STREET",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95203",
            "telephone_number": "209-425-1645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1976 W ROSE STREET",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95203",
            "telephone_number": "209-425-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZDRADZINSKI",
        "first_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8520",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY25566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Stockton, CA
• Providers in Stockton, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.