John Pietrzak, PSY.D.
Individual provider Active NPI Clinical Psychologist · Topanga, CA
NPI 1922480946 · NPPES record last updated Dec 13, 2024
Key facts
- NPI
- 1922480946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY27360 (CA)
- Practice address
- 21838 Encina Rd
Topanga, CA 90290-3527 - Phone
- (310) 663-7163
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
9709 Artesia Blvd
Suite 101
Bellflower, CA 90706-8007
Phone (310) 663-7163
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150908002375 | CA | Practitioner - Clinical Psychologist | 2062728991 |
Reassigns benefits to 1 organization Practice locations: Topanga, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27360 | CA | MD | Clinical Psychologist |
| 27360 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY27360 | CA | Yes |
Addresses
Primary practice location
21838 Encina Rd
Topanga, CA 90290-3527
Mailing address
21838 Encina Rd
Topanga, CA 90290-3527
Phone (310) 663-7163
Other practice location 1
9709 Artesia Blvd Ste 101
Bellflower, CA 90706-8007
Phone (310) 663-7163
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY27360 | Other | CA | STATE LICENSE |
| CB240514 | Medicaid | CA |
Other providers in Topanga, CA
- Mari Murao
- Eldrid Merete Odriscoll
- Mari Christina Oxenberg
- Paradise Health Aco, LLC
- Rebekah Marie Pauly
- Andrea Maria Floren Polard
- Asya Rachitsky
- Marc Erin Reznikoff
- Roland W. Jacobs, MD, PC
- Ashana Ross
All providers in Topanga, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.