Active NPI
David N Entwistle, PSYD
- Clinical Psychologist
- Medina, OH
National Provider Identifier
1851956551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P.5282
- Practice address
- 3591 Reserve Commons Dr Ste 301
Medina, OH 44256-5334 - Phone
- (330) 764-7916
- Fax
- (330) 723-6399
- NPI assigned
- May 8, 2019
- Sex
- Male
- 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 Psychologist | 103TC0700X | P.5282 | OH | Primary |
Addresses
Primary practice location
3591 Reserve Commons Dr Ste 301
Medina, OH 44256-5334
Mailing address
3591 Reserve Commons Dr Ste 301
Medina, OH 44256-5334
Phone (330) 764-7916
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P.5282 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1851956551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3591 RESERVE COMMONS DR STE 301",
"city": "MEDINA",
"state": "OH",
"postal_code": "442565334",
"telephone_number": "330-764-7916",
"fax_number": "330-723-6399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3591 RESERVE COMMONS DR STE 301",
"city": "MEDINA",
"state": "OH",
"postal_code": "442565334",
"telephone_number": "330-764-7916",
"fax_number": "330-723-6399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENTWISTLE",
"first_name": "DAVID",
"middle_name": "N",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "P.5282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.