NPIMap

Organization Active NPI

Pasadena Clinical Group, a Psychology Corporation

  • Psychologist
  • Pasadena, CA
National Provider Identifier
1790213247
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PASADENA CLINICAL GROUP, A PSYCHOLOGY CORPORATION
Practice address
595 E Colorado Blvd Ste 428
Pasadena, CA 91101-2058
Phone
(626) 354-6440
Fax
(805) 456-5547
NPI assigned
May 29, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Vincenzo Israel Piccirillo, PSYDNPI 1275943078
Title
Psychologist
Phone
(626) 354-6440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary
Addiction (Substance Use Disorder) Psychologist 103TA0400X NU
Adult Development & Aging Psychologist 103TA0700X NU
Clinical Psychologist 103TC0700X NU
Group Psychotherapy Psychologist 103TP2701X NU

Addresses

Primary practice location

595 E Colorado Blvd Ste 428
Pasadena, CA 91101-2058

Mailing address

PO Box 5581
Pasadena, CA 91117-0581
Phone (626) 354-6440

Other practice location 1

16787 Beach Blvd # 1001
Huntington Beach, CA 92647-4848
Phone (657) 204-6014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170921002169 CA Part B Supplier - Clinic/Group Practice 6002180577 Receives reassigned benefits from 2 practitioners
Practice locations: Pasadena, CA; Huntington Beach, CA

National Provider Directory

National Provider Directory

Locations

321 N Rampart St
Ste 428
Orange, CA 92868

2810 E Del Mar Blvd
Pasadena, CA 91107
Phone (562) 666-9055

2810 E Del Mar Blvd
Ste C5
Pasadena, CA 91107

790 E Colorado Blvd
Fl 9
Pasadena, CA 91101
Phone (626) 354-6440

Practitioners & affiliated clinicians

Practitioners 93

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1496016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790213247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5581",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911170581",
            "telephone_number": "626-354-6440",
            "fax_number": "805-456-5547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 E COLORADO BLVD STE 428",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012058",
            "telephone_number": "626-354-6440",
            "fax_number": "805-456-5547"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16787 Beach Blvd # 1001",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926474848",
            "country_code": "US",
            "telephone_number": "657-204-6014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PASADENA CLINICAL GROUP, A PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PICCIRILLO",
        "authorized_official_first_name": "VINCENZO",
        "authorized_official_middle_name": "ISRAEL",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "626-354-6440",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.