Active NPI
Amanda Mason, PSY.D
- Clinical Psychologist
- San Rafael, CA
National Provider Identifier
1275897480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 26711
- Practice address
- 184 Cobblestone Dr
San Rafael, CA 94903-1510 - Phone
- (415) 370-4256
- NPI assigned
- Jul 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY26711 | CA | |
| Family Psychologist | 103TF0000X | |||
| Clinical Psychologist | 103TC0700X | 26711 | CA | Primary |
Addresses
Primary practice location
184 Cobblestone Dr
San Rafael, CA 94903-1510
Mailing address
184 Cobblestone Dr
San Rafael, CA 94903-1510
Phone (415) 370-4256
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 |
|---|---|---|---|
| PSY26711 | CA | MD | Clinical Neuropsychologist |
| 26711 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594080000000",
"number": "1275897480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "184 COBBLESTONE DR",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031510",
"telephone_number": "415-370-4256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "184 COBBLESTONE DR",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031510",
"telephone_number": "415-370-4256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASON",
"first_name": "AMANDA",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-02",
"last_updated": "2020-07-07",
"certification_date": "2020-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY26711",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "26711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.