Embodied Self Psychology, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EMBODIED SELF PSYCHOLOGY, INC.

Practice address

29578 Serenity LN
Murrieta, CA 92563-5869

Phone

(619) 361-1207

Fax

(760) 452-5481

NPI assigned

Dec 4, 2023

Organization subpart

No

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

Authorized official

Name

Brenda Gomez, PSY.D.NPI 1437787249

Title

Ceo

Phone

(619) 361-1207

Specialties & licenses 7

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brenda L Gomez, PSYD

  • Psychologist
  • Carlsbad, CA
  • NPI 1437787249
  NPD Authorized official

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1851167506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29578 SERENITY LN",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925635869",
            "telephone_number": "619-361-1207",
            "fax_number": "760-452-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29578 SERENITY LN",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925635869",
            "telephone_number": "619-361-1207",
            "fax_number": "760-452-5481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 14th St Ste E",
            "address_purpose": "LOCATION",
            "city": "Del Mar",
            "state": "CA",
            "postal_code": "920142554",
            "country_code": "US",
            "telephone_number": "619-361-1207",
            "fax_number": "760-452-5481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EMBODIED SELF PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-02",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-361-1207",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI1",
            "identifier": "1437787249",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; 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.