Vivian Fernandez Credidio, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10441 Issued in CA

Practice address

806 Manhattan Beach BL
Ste 207
Manhattan Beach, CA 90266

Phone

(310) 376-3388

Fax

(310) 372-0198

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psychological Wellness

  • Clinical Psychologist
  • Manhattan Beach, CA
  • NPI 1134375983
  NPD (past) Authorized official
• Natalie Thome, Licensed Clinical Social Worker, Inc.

  • Clinical Social Worker
  • Manhattan Beach, CA
  • NPI 1932981164
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992883037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 MANHATTAN BEACH BL",
            "address_2": "STE 207",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "90266",
            "telephone_number": "310-376-3388",
            "fax_number": "310-372-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 MANHATTAN BEACH BL",
            "address_2": "STE 207",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "90266",
            "telephone_number": "310-376-3388",
            "fax_number": "310-372-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREDIDIO",
        "first_name": "VIVIAN",
        "middle_name": "FERNANDEZ",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corona Hospital Partners Inc
• Nicole Cortez
• Stan Dean Corzine, L. AC.
• Mark Costopoulos, D.P.M.
• Cove Medical, PC
• Hersey Cruz
• John P Curren, DDS
• Jennifer Colleen Curry, DPT
• Christine V Curtis, M.D.
• Ana Cutovic

• Clinical Psychologist in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Clinical Psychologist in California

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.