CDCR
NPI 1134558240
Psychologist in Ione, CA

Active since November 08, 2013
4001 HIGHWAY 104, IONE, CA 95640(209) 274-4911(209) 274-5147 Get Directions Write a Review

NPPES record last updated: November 8, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cdcr NPPES

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

CDCR (NPI 1134558240) is a healthcare organization registered as a psychologist in Ione, California and active in the NPI registry since November 2013. The organization lists Ko Bruce Fang, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1134558240
Entity TypeOrganization
Primary Taxonomy103T00000X
Legal Business NameCDCR
Location Address4001 HIGHWAY 104Ione, CA 95640
Mailing Address5215 Lotus Pond WayElk Grove, CA 95757-4342 · (916) 296-5089
Fax(209) 274-5147
Organization SubpartNo
Authorized OfficialKo Bruce FangPsychologist · (209) 274-4911
Enumeration DateNovember 8, 2013
NPI 1134558240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY18841
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.
4001 HIGHWAY 104, Ione, CA 95640

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

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

Dentist
4001 HIGHWAY 104
IONE, CA 95640
Psychologist
4001 HIGHWAY 104
IONE, CA 95640
General Practice
4001 HIGHWAY 104
IONE, CA 95640
Psychologist (Clinical)
4001 HIGHWAY 104
IONE, CA 95640
General Practice
4001 HIGHWAY 104
IONE, CA 95640
Student in an Organized Health Care Education/Training Program
4001 HIGHWAY 104
IONE, CA 95640
Social Worker (Clinical)
4001 HIGHWAY 104
IONE, CA 95640
Internal Medicine
4001 HIGHWAY 104
IONE, CA 95640

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 Cdcr's NPI number?

The NPI number for Cdcr is 1134558240. It was assigned to this organization in the NPPES registry on November 8, 2013.

Where is Cdcr located?

Cdcr is located at 4001 Highway 104, Ione, CA 95640. The listed phone number is (209) 274-4911.

What is Cdcr's specialty?

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

When was this NPI record last updated?

The NPPES record for Cdcr was last updated on November 8, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.