Active NPI
Jennifer Ann Malabag-Evans, PSYD
- Clinical Psychologist
- Pleasant Hill, CA
National Provider Identifier
1255487815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30400
- Practice address
- 2255 Morello Ave Ste 233
Pleasant Hill, CA 94523-1897 - Phone
- (925) 490-0512
- Fax
- (925) 954-6935
- NPI assigned
- Jan 26, 2007
- Last updated
- Aug 25, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30400 | CA | Primary |
Addresses
Primary practice location
2255 Morello Ave Ste 233
Pleasant Hill, CA 94523-1897
Mailing address
2255 Morello Ave Ste 233
Pleasant Hill, CA 94523-1897
Phone (925) 490-0512
Other practice location 1
399 Taylor Blvd Ste 210
Pleasant Hill, CA 94523-2287
Phone (925) 490-0512
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30400 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Roots Psychotherapy | Past | Accepting new patients | |
| Encore Clinical Consultation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Pleasant Hill, CA
- NPI 1235773177
-
- Mental Health Counselor
- Pleasant Hill, CA
- NPI 1235086976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598313600000",
"number": "1255487815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2255 MORELLO AVE STE 233",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945231897",
"telephone_number": "925-490-0512",
"fax_number": "925-954-6935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2255 MORELLO AVE STE 233",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945231897",
"telephone_number": "925-490-0512",
"fax_number": "925-954-6935"
}
],
"practiceLocations": [
{
"address_1": "399 Taylor Blvd Ste 210",
"address_purpose": "LOCATION",
"city": "Pleasant Hill",
"state": "CA",
"postal_code": "945232287",
"country_code": "US",
"telephone_number": "925-490-0512",
"fax_number": "925-685-9682",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MALABAG-EVANS",
"first_name": "JENNIFER",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Hill, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.