CDCR (NPI# 1134558240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134558240 |
| Entity Type | Organization |
| Organization Name | CDCR |
| Practice Address |
4001 Highway 104 Ione CA 95640 |
| Mailing Address |
5215 Lotus Pond Way Elk Grove CA 95757-4342 |
| Practice Telephone | 2092744911 |
| Practice Fax Number | 2092745147 |
| Mailing Telephone | 9162965089 |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |
| Authorized Official Name | KO BRUCE FANG (PSYCHOLOGIST) |
| Authorized Official Telephone | 2092744911 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | PSY18841 | CA | Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | CDCR LLC | 1251 Avenue of The Americas, Attn: Robert Unger, Esq., New York, New York 10020 |
| Colorado Business Entities | CDCreative LLC | 365 Straight Creek Dr. A, Dillon, CO 80435 |
| Street Address |
4001 HIGHWAY 104 |
| City | IONE |
| State | CA |
| Zip Code | 95640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841251105 | Joseph Chudy | Family Medicine | 4001 Highway 104, Ione, CA 95640 | 2006-03-28 |
| 1134720725 | Ava Le | Psychologist | 4001 Highway 104, Ione, CA 95640 | 2020-11-02 |
| 1821602855 | Marina Protsenko | Social Worker | 4001 Highway 104, Ione, CA 95640 | 2020-09-08 |
| 1427407832 | Melissa Derrick | Nurse Practitioner | 4001 Highway 104, Ione, CA 95640 | 2016-06-07 |
| 1669883336 | Kathleen Ann Keller | Psychologist | 4001 Highway 104, Ione, CA 95640-9099 | 2014-05-15 |
| 1316287089 | Debra Ruth Laughlin | Social Worker | 4001 Highway 104, Ione, CA 95640 | 2013-02-18 |
| 1982952230 | Kelsey Tumiel | Counselor | 4001 Highway 104, Ione, CA 95640 | 2012-08-16 |
| 1497068878 | Amy Smith | Counselor | 4001 Highway 104, Ione, CA 95640 | 2010-07-14 |
| 1073846291 | Marshay L. Anderson | Counselor | 4001 Highway 104, Ione, CA 95640 | 2009-09-08 |
| 1053549774 | Annie Gutierrez | Psychologist | 4001 Highway 104, Ione, CA 95640 | 2009-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316423692 | Millie Georganna Herrera | Psychologist | 4001 State Higheay 104, Ione, CA 95640 | 2018-07-19 |
| 1164810370 | Sarah D Smith | Psychologist | 4001 Highway-104, Ione, CA 95640 | 2014-12-23 |
| 1992130108 | Robert W Landry | Psychologist | 4001 Hwy. 104, Ione, CA 95640 | 2013-09-06 |
| 1629414735 | Teresa Stevenson | Psychologist | 4001 California Highway 104, Ione, CA 95640 | 2013-05-15 |
| 1629319215 | Kristina Towner | Social Worker | Mcsp, 4001 Hwy 104, Attn: Mental Health Services Department, Ione, CA 95640 | 2013-03-07 |
| 1437495256 | Robert Charles Arnold | Psychologist | 4001 Ca-104, Ione, CA 95640 | 2012-12-26 |
| 1518214741 | Brandy Malloy | Student in an Organized Health Care Education/Training Program | 4001 Highway 101, Ione, CA 95640 | 2012-08-07 |
| 1215296918 | Wayne J Batalo | Pharmacist | 4001 Highway 102, Ione, CA 95640 | 2012-05-15 |
| 1447402920 | Allison L.v. Andres | Psychologist | 4001 Highway 104 Mental Health Department, Mule Creek State Prison (csp-mcsp), Ione, CA 95640 | 2008-10-16 |
| 1295930188 | Evalyn Horowitz | Internal Medicine | 4001 California 104, Ione, CA 95640 | 2007-06-19 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| 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. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164810370 | Sarah D Smith | Psychologist | 4001 Highway-104, Ione, CA 95640 | 2014-12-23 |
| 1992130108 | Robert W Landry | Psychologist | 4001 Hwy. 104, Ione, CA 95640 | 2013-09-06 |
| 1447402920 | Allison L.v. Andres | Psychologist | 4001 Highway 104 Mental Health Department, Mule Creek State Prison (csp-mcsp), Ione, CA 95640 | 2008-10-16 |
| 1184773962 | Carlos Guerra Dreiss | Psychologist | 455 Eagle Dr, Ione, CA 95640-4504 | 2007-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992306690 | Eileen Kay Laughman | Psychologist | 24545 Town Center Dr Apt 5406, Valencia, CA 91355-1397 | 2020-11-08 |
| 1194324954 | Rachel Charman | Psychologist | 1001 Dove St Ste 110, Newport Beach, CA 92660-2845 | 2020-10-22 |
| 1700485760 | Melissa Ernestine Munoz | Psychologist | 353 H St # 1517, Chula Vista, CA 91910-5501 | 2020-10-21 |
| 1235737669 | Maha Nasrallah-babenko | Psychologist | 33442 Valley View Ct, Dana Point, CA 92629-1515 | 2020-10-16 |
| 1689272544 | Kaleidoscope Solutions Family Therapy | Psychologist | 25876 The Old Road, #85, Stevenson Ranch, CA 91381 | 2020-10-13 |
| 1992302814 | Sheena Gill | Psychologist | 2501 E Chapman Ave Ste 265, Fullerton, CA 92831-3108 | 2020-10-04 |
| 1255948600 | Kesha Patrice | Psychologist | 939 Ellis St, San Francisco, CA 94109-7714 | 2020-09-29 |
| 1841807401 | Midori K Dirig | Psychologist | 405 W. 3rd Street, Santa Ana, CA 92701 | 2020-09-28 |
| 1376159541 | Jill Caryn Campbell | Psychologist | 342 Ocho Rios Way, Oak Park, CA 91377-5541 | 2020-09-22 |
| 1225644487 | Brock Louis Pistel | Psychologist | 939 Ellis St Fl 67, San Francisco, CA 94109-7714 | 2020-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.