Active NPI
Damien Gonsalves, MFTI
- Clinical Psychologist
- Woodland Hills, CA
National Provider Identifier
1790298453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- IMF76991
- Practice address
- 6022 Variel Ave
Woodland Hills, CA 91367-3719 - Phone
- (818) 274-0304
- NPI assigned
- Nov 15, 2017
- 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 | IMF76991 | CA | Primary |
Addresses
Primary practice location
6022 Variel Ave
Woodland Hills, CA 91367-3719
Mailing address
816 1/3 W Knoll Dr
West Hollywood, CA 90069-4714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 12, 2024 through Jan 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF76991 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510704000000",
"number": "1790298453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "816 1/3 W KNOLL DR",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900694714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6022 VARIEL AVE",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913673719",
"telephone_number": "818-274-0304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONSALVES",
"first_name": "DAMIEN",
"credential": "MFTI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-15",
"last_updated": "2017-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "IMF76991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodland Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.