Karin Kip Vandervoort, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 24129 Issued in CA

Practice address

5665 College Ave Ste 330B
Oakland, CA 94618-1656

Phone

(510) 409-7219

Fax

(510) 655-1183

NPI assigned

Feb 18, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1043517568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 COLLEGE AVE STE 330B",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181656",
            "telephone_number": "510-409-7219",
            "fax_number": "510-655-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 COLLEGE AVE STE 330B",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181656",
            "telephone_number": "510-409-7219",
            "fax_number": "510-655-1183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5665 College Ave",
            "address_2": "320B",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946181625",
            "country_code": "US",
            "telephone_number": "510-409-7219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERVOORT",
        "first_name": "KARIN",
        "middle_name": "KIP",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-18",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 24129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Ray Vance Jr., MD
• Andrea Guadalupe Vancleave
• Eamon Vandaei, MD
• Denai F Vandenberg
• Sydney Vanderpool
• Dawn Vandeveer
• Marcia Grace Vandyke, PH.D.
• Guillermo Vanegas, M.D.
• Bau Vang
• Joua Vang, PA-C

• Clinical Psychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.