NICOLE VIENNA PSY.D.
NPI 1073702197
Psychologist in San Dimas, CA

Active since October 15, 2007Opted out of Medicare · through Apr 1, 2027
464 E BONITA AVE, SUITE 11, SAN DIMAS, CA 91773(626) 709-3494 Get Directions Write a Review

NPPES record last updated: February 24, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 24, 2017, Jun 29, 2016 (2 updates tracked since 2016).

About Nicole Vienna Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE VIENNA PSY.D. (NPI 1073702197) is an individual psychologist in San Dimas, California and active in the NPI registry since October 2007. She has opted out of Medicare through April 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1073702197
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameNICOLE VIENNACredential: PSY.D.
Location Address464 E BONITA AVE, SUITE 11San Dimas, CA 91773-3144
Mailing Address464 E Bonita Ave, Suite 11San Dimas, CA 91773-3144 · (626) 709-3494
Sole ProprietorYes
Enumeration DateOctober 15, 2007
Last NPPES UpdateFebruary 24, 20172 updates tracked since enumeration
NPI 1073702197 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
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.
464 E BONITA AVE, San Dimas, CA 91773

Other Names 1

Former Name (1)Nicole Radford

Other Identifiers 1

Medicare PINCB261945CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Nicole Vienna Psy.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2019 through April 1, 2027.

Opt-Out Effective DateApril 1, 2019
Opt-Out In Effect ThroughApril 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
464 E BONITA AVE, SUITE 11
SAN DIMAS, CA 91773

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Vienna's NPI number?

The NPI number for Nicole Vienna is 1073702197. It was assigned to this individual provider in the NPPES registry on October 15, 2007. The provider is also known as Nicole Radford.

Where is Nicole Vienna located?

Nicole Vienna practices at 464 E Bonita Ave Suite 11, San Dimas, CA 91773. The listed phone number is (626) 709-3494.

What is Nicole Vienna's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Nicole Vienna enrolled in Medicare?

No. Nicole Vienna has opted out of Medicare through April 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Nicole Vienna was last updated on February 24, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.