Angela Susan Ballard, LMFT 120205, PCCI

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LMFT120205 Issued in CA

Practice address

1033 Laurel St
San Carlos, CA 94070-3918

Phone

(650) 785-2562

NPI assigned

Aug 2, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1013431899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CHESTER ST",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940252517",
            "telephone_number": "650-862-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 LAUREL ST",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940703918",
            "telephone_number": "650-785-2562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "ANGELA",
        "middle_name": "SUSAN",
        "credential": "LMFT 120205, PCCI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "LMFT120205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Steven Baker, M.D.
• Catherine Baker, M.D.
• Jean E Baker, L.C.S.W.
• Jeffrey Baker, MPT
• Lynne A Baldassari-Cruz, D.D.S.
• Hannah Rose Banks
• Norman Leroy Banks, MD
• Ritu Bansal
• Ivana T Barrios
• Anne Germaine Barry, AMFT

• Clinical Psychologist in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.