Active NPI
Vanessa Marielle Holtgrave, PSY.D., M.S.
- Clinical Psychologist
- Santa Maria, CA
National Provider Identifier
1942598131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29670
- Practice address
- 2615 S Miller St Ste 106
Santa Maria, CA 93455-1775 - Phone
- (618) 304-0212
- NPI assigned
- Jul 21, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Psychologist | 103TC0700X | 29670 | CA | Primary |
Addresses
Primary practice location
2615 S Miller St Ste 106
Santa Maria, CA 93455-1775
Mailing address
2615 S Miller St Ste 106
Santa Maria, CA 93455-1775
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29670 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511222400000",
"number": "1942598131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2615 S MILLER ST STE 106",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934551775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2615 S MILLER ST STE 106",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934551775",
"telephone_number": "618-304-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLTGRAVE",
"first_name": "VANESSA",
"middle_name": "MARIELLE",
"name_prefix": "Dr.",
"credential": "PSY.D., M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-21",
"last_updated": "2017-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Maria, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.