Active NPI
Jennifer Ly, PH.D.
- Clinical Child & Adolescent Psychologist
- San Francisco, CA
National Provider Identifier
1306131503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 27393
- Practice address
- 675 18TH Street
San Francisco, CA 94143-3134 - Phone
- (415) 476-3658
- Fax
- (415) 502-6361
- NPI assigned
- Jun 15, 2011
- 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 Child & Adolescent Psychologist | 103TC2200X | 27393 | CA | Primary |
Addresses
Primary practice location
675 18TH Street
San Francisco, CA 94143-3134
Mailing address
675 18TH Street, Box 3136
San Francisco, CA 94143-3134
Phone (415) 476-3658
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27393 | CA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685577600000",
"number": "1306131503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 18TH STREET, BOX 3136",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941433134",
"telephone_number": "415-476-3658",
"fax_number": "415-502-6361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 18TH STREET",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941433134",
"telephone_number": "415-476-3658",
"fax_number": "415-502-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-15",
"last_updated": "2023-06-01",
"certification_date": "2023-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "27393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.