Active NPI
Hymavathi Devi Kunamneni, PH.D
- Clinical Child & Adolescent Psychologist
- Stockton, CA
National Provider Identifier
1851304786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PSY17013
- Practice address
- 1805 N California St Ste 202
Stockton, CA 95204-6032 - Phone
- (209) 469-3690
- Fax
- (209) 467-1502
- NPI assigned
- Aug 14, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY17013 | CA | Primary |
Addresses
Primary practice location
1805 N California St Ste 202
Stockton, CA 95204-6032
Mailing address
1805 N California St Ste 202
Stockton, CA 95204-6032
Phone (209) 469-3690
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A-05-688 | Other | CA | ACCESS MANAGED CARE |
| OPL170130 | Other | CA | BLUE SHIELD |
| PSY170130 | Medicaid | CA | |
| P00089953 | Other | CA | PALMETTO GBA |
| 447320 | Other | CA | VALUE OPTIONS |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY17013 | CA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851304786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1805 N CALIFORNIA ST STE 202",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952046032",
"telephone_number": "209-469-3690",
"fax_number": "209-467-1502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1805 N CALIFORNIA ST STE 202",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952046032",
"telephone_number": "209-469-3690",
"fax_number": "209-467-1502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNAMNENI",
"first_name": "HYMAVATHI",
"middle_name": "DEVI",
"name_prefix": "Mrs.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY17013",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACCESS MANAGED CARE",
"identifier": "A-05-688",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "OPL170130",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY170130",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "P00089953",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "447320",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.