Active NPI
Mary C Lamia, PH.D.
- Clinical Psychologist
- Kentfield, CA
National Provider Identifier
1336292309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 5712
- Practice address
- 1030 Sir Francis Drake Blvd
Kentfield, CA 94904-1411 - Phone
- (415) 457-2839
- NPI assigned
- Jan 20, 2007
- 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 | PSY 5712 | CA | Primary |
Addresses
Primary practice location
1030 Sir Francis Drake Blvd
Kentfield, CA 94904-1411
Mailing address
PO Box 163
Kentfield, CA 94914-0163
Phone (415) 457-2839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 11, 2022 through Jun 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 5712 | CA | MD | Clinical Psychologist |
| 5712 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336292309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 163",
"city": "KENTFIELD",
"state": "CA",
"postal_code": "949140163",
"telephone_number": "415-457-2839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 SIR FRANCIS DRAKE BLVD",
"city": "KENTFIELD",
"state": "CA",
"postal_code": "949041411",
"telephone_number": "415-457-2839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAMIA",
"first_name": "MARY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 5712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kentfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.