NPIMap

Organization Active NPI

Santa Monica Therapy, a Psychology Corporation

  • Clinical Psychologist
  • Santa Monica, CA
National Provider Identifier
1962967372
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SANTA MONICA THERAPY, A PSYCHOLOGY CORPORATION
Practice address
3301 Ocean Park Blvd Ste 210
Santa Monica, CA 90405-3230
Phone
(310) 845-6720
NPI assigned
Feb 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy Wong, PH.D.NPI 1043588775
Title
Owner
Phone
(310) 845-6720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

3301 Ocean Park Blvd Ste 210
Santa Monica, CA 90405-3230

Mailing address

3301 Ocean Park Blvd Ste 210
Santa Monica, CA 90405-3230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190413000167 CA Part B Supplier - Clinic/Group Practice 7012258346 Receives reassigned benefits from 2 practitioners
Practice locations: Santa Monica, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1962967372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 OCEAN PARK BLVD STE 210",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904053230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 OCEAN PARK BLVD STE 210",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904053230",
            "telephone_number": "310-845-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MONICA THERAPY, A PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-11",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-845-6720",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.