Individual provider Active NPI

Larry Samuel Moricca, PH.D.

  • Clinical Psychologist
  • Clovis, CA
National Provider Identifier
1851441810
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY7595 Issued in CA
Practice address
642 Pollasky Ave
#210
Clovis, CA 93612-1875
Phone
(559) 999-0143
Fax
(559) 412-2104
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY7595 CA Primary

Addresses

Primary practice location

642 Pollasky Ave
#210
Clovis, CA 93612-1875

Mailing address

12588 Cades Bay Cir
Bradenton, FL 34211-1604
Phone (559) 999-0143

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120222000137 CA Practitioner - Clinical Psychologist 5092973065 Practice locations: Clovis, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

642 Pollasky Ave
Suite 210
Clovis, CA 93612-1875
Phone (559) 999-0143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY7595CAMDClinical Psychologist
7595CAMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1851441810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12588 CADES BAY CIR",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342111604",
            "telephone_number": "559-999-0143",
            "fax_number": "559-412-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 POLLASKY AVE",
            "address_2": "#210",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121875",
            "telephone_number": "559-999-0143",
            "fax_number": "559-412-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORICCA",
        "first_name": "LARRY",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY7595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.