Active NPI
Teresa Jean Lively, PHD
- Psychologist
- San Jose, CA
National Provider Identifier
1972665198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20059
- Practice address
- 5755 Cottle Rd
San Jose, CA 95123-3640 - Phone
- (408) 363-4904
- Fax
- (408) 972-3242
- NPI assigned
- Dec 14, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20059 | CA | Primary |
Addresses
Primary practice location
5755 Cottle Rd
San Jose, CA 95123-3640
Mailing address
5755 Cottle Rd
San Jose, CA 95123-3640
Phone (408) 363-4904
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20059 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972665198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5755 COTTLE RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951233640",
"telephone_number": "408-363-4904",
"fax_number": "408-972-3242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5755 COTTLE RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951233640",
"telephone_number": "408-363-4904",
"fax_number": "408-972-3242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVELY",
"first_name": "TERESA",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "20059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.