Pamela Deritis, LMFT151030

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

116077 Issued in CA

Practice address

16405 Rosewood St
Fountain Valley, CA 92708-1938

Phone

(323) 380-8857

NPI assigned

Aug 17, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1841966322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16405 ROSEWOOD ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927081938",
            "telephone_number": "714-717-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16405 ROSEWOOD ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927081938",
            "telephone_number": "323-380-8857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "740 W 190th St # A",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484235",
            "country_code": "US",
            "telephone_number": "562-306-2925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERITIS",
        "first_name": "PAMELA",
        "credential": "LMFT151030",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "116077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise M. Urkov Chiropractic Corp.
• Tanya M Denne, ND
• Douglas E Dennis, M.D.
• Denny Le MD & Associates
• Gian Patrick Densing
• Vivian Derr, CPNP
• Desanto Clinics
• Angelina Teresa Desanto, LCSW
• Joseph A. Desanto, M.D.
• Kavita P. Deshpande, M.D.

• Marriage & Family Therapist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.