Individual provider Active NPI

Ruth Fallenbaum, PHD

  • Psychologist
  • Berkeley, CA
National Provider Identifier
1245355833
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY 9070 Issued in CA
Practice address
3120 Telegraph Ave
Suite 1
Berkeley, CA 94705-1900
Phone
(510) 835-2368
NPI assigned
Mar 20, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY 9070 CA Primary

Addresses

Primary practice location

3120 Telegraph Ave
Suite 1
Berkeley, CA 94705-1900

Mailing address

3120 Telegraph Ave
Suite 1
Berkeley, CA 94705-1900
Phone (510) 835-2368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050203000297 CA Practitioner - Clinical Psychologist 4981655248 Practice locations: Oakland, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2100 Lakeshore Ave
Suite B
Oakland, CA 94606-1188
Phone (510) 841-4026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 9070CAMDPsychologist
9070CAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245355833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 TELEGRAPH AVE",
            "address_2": "SUITE 1",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051900",
            "telephone_number": "510-835-2368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 TELEGRAPH AVE",
            "address_2": "SUITE 1",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051900",
            "telephone_number": "510-835-2368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLENBAUM",
        "first_name": "RUTH",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 9070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.