JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC. , NPI 1215910989 — SAN DIEGO (CA)

NPI 1215910989

14+ Years Experience Organization

JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC.

11/26/2005
PROVIDER ENUMERATION DATE
07.09.2007
LAST UPDATE DATE
1215910989
NPI NUMBER

About JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC.

JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC. is a provider established in SAN DIEGO, CA. The NPI number of JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC. is 1215910989 and was assigned on 11/26/2005. The practitioners primary taxonomy code is: 103T00000X with license number: PSY15145 CA .

Mailing address

  • City: SAN DIEGO
  • State: CA
  • Postal code: 921281401
  • Phone: 8586744913
  • Address: 12535 CAMINO EMPARRADO

Primary Practice Address

  • Region : SAN DIEGO, CA
  • NPI : 1215910989
  • Phone : 8586744913
  • Postalcode : 921281401
  • Address : 12535 CAMINO EMPARRADO

Additional identifiers

  • Identifier: OPL151450
  • Code / Type : 1 - other
  • Identifier state : CA
  • Identifier issuer: BLUE SHIELD OF CA

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 184757
  • Code / Type : 1 - other
  • Identifier state : CA
  • Identifier issuer : MANAGED HEALTH NETWORK

Provider taxonomy - Psychologist

  • Taxonomy code: 103T00000X
  • License number: PSY15145
  • License state: CA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy group: 193400000X SINGLE SPECIALTY GROUP.

Taxonomy description: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Contacts:

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  • JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC.
  • Address : 12535 CAMINO EMPARRADO
  • Region : SAN DIEGO, CA
  • NPI : 1215910989
  • Phone : 8586744913
  • Postalcode : 921281401

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 8586744913
  • Title or position : CEO/OWNER
  • Credentials : PH.D.

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address12535 CAMINO EMPARRADO
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameSAN DIEGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code921281401
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number8586744913
The telephone number associated with the location address of the provider being identified.
NPI1215910989
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1103T00000X
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Provider Enumeration Date11/26/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.09.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)JOANNE J. WENDT, PH.D., CLINICAL PSYCHOLOGIST, INC.
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address12535 CAMINO EMPARRADO
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameSAN DIEGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code921281401
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number8586744913
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Authorized Official Last NameWENDT
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJOANNE
The first name of the authorized official
Authorized Official Middle NameJEAN
The middle name of the authorized official
Authorized Official Title or PositionCEO/OWNER
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextPH.D.
Authorized Official Credential Text
Authorized Official Telephone Number8586744913
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1103T00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Psychologist
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Provider License Number 1PSY15145
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1CA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1OPL151450
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1CA
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BLUE SHIELD OF CA
Other Provider Identifier Issuer #1
Other Provider Identifier 2184757
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2CA
Other Provider Identifier State #2
Other Provider Identifier Issuer 2MANAGED HEALTH NETWORK
Other Provider Identifier Issuer #2
X

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