DR. CAROLYN B. SHADDUCK PH.D., PSY.D.
NPI 1891710125
Psychologist - Clinical in Santa Monica, CA

Q: What is Carolyn Shadduck's NPI number?

The NPI number for Carolyn Shadduck is 1891710125. It was assigned to this individual provider in the NPPES registry on July 13, 2006.

Q: What is Carolyn Shadduck's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Carolyn Shadduck enrolled in Medicare?

No. Carolyn Shadduck has opted out of Medicare through July 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.

Q: When was this NPI record last updated?

The NPPES record for Carolyn Shadduck was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.

Active since July 13, 2006Opted out of Medicare · through Jul 1, 2027

636 26TH ST, SANTA MONICA, CA 90402(310) 395-0436(310) 395-1887 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About Dr. Carolyn B. Shadduck Ph.d., Psy.d. NPPES

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

DR. CAROLYN B. SHADDUCK PH.D., PSY.D. (NPI 1891710125) is an individual clinical provider in Santa Monica, California, licensed in California (PSY4871) and active in the NPI registry since July 2006. She has opted out of Medicare through July 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1891710125

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. CAROLYN B. SHADDUCKCredential: PH.D., PSY.D.

Location Address636 26TH STSanta Monica, CA 90402-3148

Mailing Address636 26th StSanta Monica, CA 90402-3148 · (310) 395-0436 · Fax (310) 395-1887

Phone(310) 395-0436

Fax(310) 395-1887

Sole ProprietorYes

Enumeration DateJuly 13, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1891710125 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY4871

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

636 26TH ST, Santa Monica, CA 90402

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Other Identifiers 1

OtherPSY4871CA · License As A Psychologist

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Carolyn B. Shadduck Ph.d., 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 July 1, 2015 through July 1, 2027.

Opt-Out Effective DateJuly 1, 2015

Opt-Out In Effect ThroughJuly 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90402 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

$187.60 typical visit price

range $62.96 – $187.60

Typical copayment $46.90 (range $15.74 – $46.90)

Most-billed visit code 99205

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.

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 Carolyn Shadduck's NPI number?

The NPI number for Carolyn Shadduck is 1891710125. It was assigned to this individual provider in the NPPES registry on July 13, 2006.

Where is Carolyn Shadduck located?

Carolyn Shadduck practices at 636 26th St, Santa Monica, CA 90402. The listed phone number is (310) 395-0436.

What is Carolyn Shadduck's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Carolyn Shadduck enrolled in Medicare?

No. Carolyn Shadduck has opted out of Medicare through July 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 Carolyn Shadduck was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.