Active NPI
Eva Chiriboga, PSY.D.
- Clinical Psychologist
- Silver Spring, MD
National Provider Identifier
1811435761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 06543
- Practice address
- 8630 Fenton St Ste 328
Silver Spring, MD 20910-3816 - Phone
- (301) 328-1625
- NPI assigned
- Feb 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810007358 | VA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | 06543 | MD | Primary |
Addresses
Primary practice location
8630 Fenton St Ste 328
Silver Spring, MD 20910-3816
Mailing address
8630 Fenton St Ste 328
Silver Spring, MD 20910-3816
Phone (301) 328-1625
Other practice location 1
3018 Broadway
Apt 3A
Astoria, NY 11106-2883
Phone (410) 949-7943
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06543 | Other | MD | STATE LICENSE |
| 0810007358 | Other | VA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06543 | MD | MD | Clinical Psychologist |
| 0810007358 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1811435761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8630 FENTON ST STE 328",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209103816",
"telephone_number": "301-328-1625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8630 FENTON ST STE 328",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209103816",
"telephone_number": "301-328-1625"
}
],
"practiceLocations": [
{
"address_1": "3018 Broadway",
"address_2": "Apt 3A",
"address_purpose": "LOCATION",
"city": "Astoria",
"state": "NY",
"postal_code": "111062883",
"country_code": "US",
"telephone_number": "410-949-7943",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHIRIBOGA",
"first_name": "EVA",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-10",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810007358",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "06543",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "06543",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "0810007358",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.