Individual provider Active NPI

Shlomit Smargon, PSYD

  • Psychologist
  • Bellingham, WA
National Provider Identifier
1801120290
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY60820896 Issued in WA
Practice address
4109 Consolidation Ave
Bellingham, WA 98229-2859
Phone
(831) 359-1420
NPI assigned
Oct 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY60820896 WA Primary

Addresses

Primary practice location

4109 Consolidation Ave
Bellingham, WA 98229-2859

Mailing address

4109 Consolidation Ave Apt C201
Bellingham, WA 98229-2859
Phone (831) 359-1420

Other identifiers 1

IdentifierTypeStateIssuer
2101112MedicaidWA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20211006002217 WA Practitioner - Clinical Psychologist 1850799719

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY60820896WAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Beautiful Autism CurrentSince May 19, 2021 Accepting new patients

Locations

17825 59th Ave NE
Ste B
Arlington, WA 98223
Phone (360) 363-4234

16710 Smokey Point Blvd
Ste 402
Arlington, WA 98223
Phone (360) 363-4234

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1801120290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 CONSOLIDATION AVE APT C201",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982292859",
            "telephone_number": "831-359-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 CONSOLIDATION AVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982292859",
            "telephone_number": "831-359-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMARGON",
        "first_name": "SHLOMIT",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-01",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60820896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2101112",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

Verify at the official NPI Registry.