Active NPI
Jane Leslie Weisbin, PSY.D.
- Psychologist
- Berkeley, CA
National Provider Identifier
1124047915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY20197
- Practice address
- 3030 Ashby Ave
Suite 107a
Berkeley, CA 94705-2439 - Phone
- (510) 601-0784
- Fax
- (510) 601-0784
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY20197 | CA | Primary |
Addresses
Primary practice location
3030 Ashby Ave
Suite 107a
Berkeley, CA 94705-2439
Mailing address
3030 Ashby Ave
Berkeley, CA 94705-2439
Phone (510) 601-0784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2014 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20197 | CA | MD | Psychologist |
| 20197 | CA | MD | Pediatric Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124047915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3030 ASHBY AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947052439",
"telephone_number": "510-601-0784",
"fax_number": "510-601-0784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3030 ASHBY AVE",
"address_2": "SUITE 107A",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947052439",
"telephone_number": "510-601-0784",
"fax_number": "510-601-0784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEISBIN",
"first_name": "JANE",
"middle_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY20197",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.