Active NPI
Katya Woodmansee, PH.D.
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1124282801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY21696
- Practice address
- 2931 Shattuck Ave # 104
Berkeley, CA 94705-1986 - Phone
- (510) 595-4670
- NPI assigned
- Jul 11, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY21696 | CA | |
| Clinical Psychologist | 103TC0700X | PSY21696 | CA | Primary |
Addresses
Primary practice location
2931 Shattuck Ave # 104
Berkeley, CA 94705-1986
Mailing address
2931 Shattuck Ave # 104
Berkeley, CA 94705-1986
Phone (510) 595-4670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY21696 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629417600000",
"number": "1124282801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2931 SHATTUCK AVE # 104",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051986",
"telephone_number": "510-595-4670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2931 SHATTUCK AVE # 104",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051986",
"telephone_number": "510-595-4670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODMANSEE",
"first_name": "KATYA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-11",
"last_updated": "2021-08-20",
"certification_date": "2021-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY21696",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY21696",
"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 Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.