Kimberly Doreatha Claggett
Individual provider Active NPI Psychologist · Patton, CA
NPI 1992997480 · NPPES record last updated Mar 18, 2026
Key facts
- NPI
- 1992997480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY32145 (CA)
- Practice address
- 3102 E Highland Ave
Patton, CA 92369-7813 - Phone
- (909) 672-9583
- NPI assigned
- Aug 17, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231218003717 | CA | Practitioner - Clinical Psychologist | 3577912468 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY32145 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY32145 | CA | |
| Psychologist | 103T00000X | PSY32145 | CA | Yes |
Addresses
Primary practice location
3102 E Highland Ave
Patton, CA 92369-7813
Mailing address
3102 E Highland Ave
Patton, CA 92369-7813
Phone (909) 672-9583
Other providers in Patton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.