Active NPI
Michael Fenske, PSYD.
- Psychologist
- Pasadena, CA
National Provider Identifier
1952181190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY34399
- Practice address
- 200 E del Mar Blvd Ste 206
Pasadena, CA 91105-2552 - Phone
- (661) 317-5051
- NPI assigned
- Oct 4, 2023
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY34399 | CA | Primary |
Addresses
Primary practice location
200 E del Mar Blvd Ste 206
Pasadena, CA 91105-2552
Mailing address
203 N San Dimas Canyon Rd Unit B217
San Dimas, CA 91773-2789
Phone (661) 317-5051
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 |
|---|---|---|---|
| PSY34399 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696377600000",
"number": "1952181190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 N SAN DIMAS CANYON RD UNIT B217",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917732789",
"telephone_number": "661-317-5051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E DEL MAR BLVD STE 206",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052552",
"telephone_number": "661-317-5051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENSKE",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-04",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY34399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.