Active NPI
Jan L Fisher, PHD
- Clinical Psychologist
- Redwood City, CA
National Provider Identifier
1306357967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 16569
- Practice address
- 61 Renato CT Ste 7
Redwood City, CA 94061-4016 - Phone
- (650) 261-6692
- NPI assigned
- Oct 22, 2017
- 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 | 16569 | CA | Primary |
Addresses
Primary practice location
61 Renato CT Ste 7
Redwood City, CA 94061-4016
Mailing address
61 Renato CT Ste 7
Redwood City, CA 94061-4016
Phone (650) 261-6692
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 15, 2021 through Oct 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16569 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508630400000",
"number": "1306357967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 RENATO CT STE 7",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940614016",
"telephone_number": "650-261-6692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 RENATO CT STE 7",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940614016",
"telephone_number": "650-261-6692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "JAN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-22",
"last_updated": "2017-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "16569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.