Active NPI
Randall Glenn Wilson, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1861685257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY 8888
- Practice address
- 3203 Clairemont Dr
Apt. 2
San Diego, CA 92117-6449 - Phone
- (732) 232-0462
- NPI assigned
- Aug 20, 2007
- Sex
- Male
- Sole proprietor
- No
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 | PY 8888 | FL | Primary |
Addresses
Primary practice location
3203 Clairemont Dr
Apt. 2
San Diego, CA 92117-6449
Mailing address
7626 Radcliffe Dr
Apt. B
Madison, WI 53719-2087
Phone (732) 232-0462
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 8888 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381276800000",
"number": "1861685257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7626 RADCLIFFE DR",
"address_2": "APT. B",
"city": "MADISON",
"state": "WI",
"postal_code": "537192087",
"telephone_number": "732-232-0462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3203 CLAIREMONT DR",
"address_2": "APT. 2",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176449",
"telephone_number": "732-232-0462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RANDALL",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-20",
"last_updated": "2013-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY 8888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.