Kelley Bryan Gin, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20624 Issued in CA

Practice address

2711 Alcatraz Ave Ste 2
Berkeley, CA 94705-2726

Phone

(510) 219-7091

Fax

(510) 269-9031

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kelley Bryan Gin, PSYD

  • Clinical Psychologist
  • Berkeley, CA
  • NPI 1972072023
  NPD Authorized official

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1194870949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 ALCATRAZ AVE STE 2",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052726",
            "telephone_number": "510-219-7091",
            "fax_number": "510-269-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 ALCATRAZ AVE STE 2",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052726",
            "telephone_number": "510-219-7091",
            "fax_number": "510-269-9031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 E 12th St",
            "address_2": "Suite 259",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946013424",
            "country_code": "US",
            "telephone_number": "510-269-9042",
            "fax_number": "510-269-9031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIN",
        "first_name": "KELLEY",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 38529",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "20624",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 20624",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gwendolyn Gill, N.P.
• Cheri Gillies, RN
• Malachi Gillihan, MA
• John Gilman, MD
• Erika L Gimbel, M.A., MFT
• Alyse Ginter
• Madeline Girard
• Camille Giraud, MD
• Nathalie Marie Gireaud-Ferko, MA, CADCII
• Cortney Given, MSW

• Psychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.