Active NPI
Barbara Ellen Fannin, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1194916957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26371
- Practice address
- 4929 Wilshire Blvd
Suite Number 510
Los Angeles, CA 90010-3808 - Phone
- (562) 904-3999
- Fax
- (855) 688-6746
- NPI assigned
- Aug 7, 2007
- Reactivated
- Mar 18, 2021
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1050 | HI | |
| Psychologist | 103T00000X | 0172541 | NY | |
| Clinical Psychologist | 103TC0700X | 1293 | NM | |
| Clinical Psychologist | 103TC0700X | PSY26371 | CA | Primary |
Addresses
Primary practice location
4929 Wilshire Blvd
Suite Number 510
Los Angeles, CA 90010-3808
Mailing address
4929 Wilshire Blvd
Suite Number 510
Los Angeles, CA 90010-3808
Phone (562) 904-3999
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1050 | HI | MD | Psychologist |
| 0172541 | NY | MD | Psychologist |
| PSY26371 | CA | MD | Clinical Psychologist |
| 1293 | NM | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616025600000",
"number": "1194916957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4929 WILSHIRE BLVD",
"address_2": "SUITE NUMBER 510",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900103808",
"telephone_number": "562-904-3999",
"fax_number": "855-688-6746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4929 WILSHIRE BLVD",
"address_2": "SUITE NUMBER 510",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900103808",
"telephone_number": "562-904-3999",
"fax_number": "855-688-6746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANNIN",
"first_name": "BARBARA",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-07",
"last_updated": "2021-03-18",
"certification_date": "2021-03-18",
"deactivation_date": "2021-02-08",
"reactivation_date": "2021-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "HI",
"license": "1050",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "0172541",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "1293",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.