Sam Kane Harary, PSYCHOLOGIST
Individual provider Active NPI Psychologist · Ione, CA
NPI 1194058248 · NPPES record last updated May 16, 2023
Key facts
- NPI
- 1194058248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY27051 (CA)
- Practice address
- 4001 Ca-104
Ione, CA 95640 - Phone
- (209) 274-4911
- NPI assigned
- Sep 8, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27051 | CA | MD | Psychologist |
| 27051 | CA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychologist | 103T00000X | PSY27051 | CA | Yes |
Addresses
Primary practice location
4001 Ca-104
Ione, CA 95640
Mailing address
974 N Circle Dr
Diamond Springs, CA 95619-9715
Phone (916) 412-2986
Other practice location 1
250 Bon Air Rd
Greenbrae, CA 94904-1702
Phone (415) 473-3527
Other providers in Ione, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.