Active NPI
Judith Carol Pickles, PH.D., PSY.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1851462576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY9886
- Practice address
- 1800 Fairburn Ave
#103
Los Angeles, CA 90025-5958 - Phone
- (310) 474-6160
- Fax
- (310) 475-6296
- NPI assigned
- Nov 13, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY9886 | CA | Primary |
Addresses
Primary practice location
1800 Fairburn Ave
#103
Los Angeles, CA 90025-5958
Mailing address
1800 Fairburn Ave
#103
Los Angeles, CA 90025-5958
Phone (310) 474-6160
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 16, 2021 through Oct 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9886 | CA | MD | Mental Health Counselor |
| PSY9886 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851462576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 FAIRBURN AVE",
"address_2": "#103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255958",
"telephone_number": "310-474-6160",
"fax_number": "310-475-6296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 FAIRBURN AVE",
"address_2": "#103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255958",
"telephone_number": "310-474-6160",
"fax_number": "310-475-6296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKLES",
"first_name": "JUDITH",
"middle_name": "CAROL",
"name_prefix": "Dr.",
"credential": "PH.D., PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY9886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.