Tyler Lee Vasconcellos, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY32249 Issued in CA

Practice address

870 Market St Ste 1057
San Francisco, CA 94102-2928

Phone

(415) 343-5286

NPI assigned

Oct 15, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Tyler Vasconcellos Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pacific Center for Human Growth

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Berkeley, CA
  • NPI 1043434095
  NPD (past)
• Pacific Center for Human Growth

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1275687717
  NPD (past)

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1801290168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051117",
            "telephone_number": "510-548-8283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 MARKET ST STE 1057",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941022928",
            "telephone_number": "415-343-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASCONCELLOS",
        "first_name": "TYLER LEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-15",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY32249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "942209679",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TYLER",
            "last_name": "VASCONCELLOS",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christina Vartanian, RN, BSN, RNFA
• Jenevieve Violet Vartanian
• Shant Vartanian, MD
• Mher Vartivarian, D.P.M.
• Reshma Vasanwala, D.O.
• Emanuelle Vasconcelos B Borba Pontual, NP
• Veronica Vasconcelos
• Vascular Associates of San Francisco
• Vera Vasey, LCSW
• Irina A Vasilyeva, MD PHD

• Clinical Psychologist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.