Simone Rodin, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY14624 Issued in CA

Practice address

1634 5TH Ave
San Rafael, CA 94901-1809

Phone

(415) 458-3358

Fax

(415) 482-0313

NPI assigned

Nov 4, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Wellspring Psychotherapy Center

  • Psychologist
  • San Rafael, CA
  • NPI 1083132310
  NPD Authorized official

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1285961755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1634 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949011809",
            "telephone_number": "415-458-3358",
            "fax_number": "415-482-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949011809",
            "telephone_number": "415-458-3358",
            "fax_number": "415-482-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODIN",
        "first_name": "SIMONE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY14624",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY 14624",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Semenza Roche, MSPT
• Kirk Allen Rockwell, D.C.
• Blake Francis Rodgers, MFT MARRIAGE FAMILY
• James G Rodgers, FNP
• Stacey M Rodgers, PSY.D.
• Camila Oliveira Rodrigues
• Sabrina Rodrigues, LAC
• Abigail Rodriguez
• Eduardo Rodriguez
• Kevin Omar Rodriguez

• Clinical Psychologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.