Active NPI
Justin Robert Chernow, PH.D.
- Clinical Psychologist
- San Luis Obispo, CA
National Provider Identifier
1790070647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 24166
- Practice address
- 1011 Pacific St Ste 200
San Luis Obispo, CA 93401-3600 - Phone
- (805) 835-7441
- NPI assigned
- Jun 17, 2011
- Last updated
- May 16, 2024
- 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 24166 | CA | Primary |
Addresses
Primary practice location
1011 Pacific St Ste 200
San Luis Obispo, CA 93401-3600
Mailing address
PO Box 3921
Paso Robles, CA 93447-3921
Phone (805) 835-7441
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230906000363 | CA | Practitioner - Clinical Psychologist | 2163885310 | Practice locations: Paso Robles, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Paso Robles, CA 93446
Phone (805) 835-7441
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 24166 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715817600000",
"number": "1790070647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3921",
"city": "PASO ROBLES",
"state": "CA",
"postal_code": "934473921",
"telephone_number": "805-835-7441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 PACIFIC ST STE 200",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934013600",
"telephone_number": "805-835-7441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHERNOW",
"first_name": "JUSTIN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-17",
"last_updated": "2024-05-16",
"certification_date": "2024-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 24166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.