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JAQUELINE ALEXIS GORODETSKY PMHNP
NPI 1619730660
Nurse Practitioner - Psychiatric/Mental Health in Panorama City, CA

Active since February 02, 2024PECOS Enrolled
14860 ROSCOE BLVD STE 307, PANORAMA CITY, CA 91402(818) 616-2122 Get Directions Write a Review

NPPES record last updated: January 1, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jaqueline Alexis Gorodetsky Pmhnp NPPES

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

JAQUELINE ALEXIS GORODETSKY PMHNP (NPI 1619730660) is an individual psychiatric/mental health provider in Panorama City, California, licensed in California (95027727) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1619730660
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameJAQUELINE ALEXIS GORODETSKYCredential: PMHNP
Location Address14860 ROSCOE BLVD STE 307Panorama City, CA 91402-4691
Mailing Address14860 Roscoe Blvd Ste 307Panorama City, CA 91402-4691
Phone(818) 616-2122
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateFebruary 2, 2024
Last NPPES UpdateJanuary 1, 2026
NPPES CertifiedJanuary 1, 2026
✔ NPI 1619730660 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CA · 95027727
14860 ROSCOE BLVD STE 307, Panorama City, CA 91402
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jaqueline Alexis Gorodetsky Pmhnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7113406356
PECOS Enrollment IDI20260209002353
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91402 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

MISS ELIZABETH MARATOVNA KHAVKINA PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
14860 ROSCOE BLVD STE 307
PANORAMA CITY, CA 91402
Los Angeles County (818) 616-2122
DONARA GASANOVA PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
14860 ROSCOE BLVD STE 307
PANORAMA CITY, CA 91402
Los Angeles County (747) 998-0387

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 Jaqueline Gorodetsky's NPI number?

The NPI number for Jaqueline Gorodetsky is 1619730660. It was assigned to this individual provider in the NPPES registry on February 2, 2024.

Where is Jaqueline Gorodetsky located?

Jaqueline Gorodetsky practices at 14860 Roscoe Blvd Ste 307, Panorama City, CA 91402. The listed phone number is (818) 616-2122.

What is Jaqueline Gorodetsky's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jaqueline Gorodetsky enrolled in Medicare?

Yes. Jaqueline Gorodetsky is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jaqueline Gorodetsky was last updated on January 1, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.