Laura Mayorga

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY19045 Issued in CA

Practice address

605 B St
San Rafael, CA 94901-3805

Phone

(415) 250-1274

Fax

(888) 365-0277

NPI assigned

Aug 24, 2015

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1356718464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6062",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949030062",
            "telephone_number": "415-250-1274",
            "fax_number": "888-365-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 B ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013805",
            "telephone_number": "415-250-1274",
            "fax_number": "888-365-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYORGA",
        "first_name": "LAURA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-24",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19045",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY19045",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Rae Matsuishi, PH.D.
• Matthew Bedell MD Inc.
• Sarah Matthews
• Stephanie Mauro, LMFT
• Samantha Maxwell, BA
• Marilyn Mazer, LMFT
• Jesse J Mazza, A.T.,C.
• Gregg Mazzariello, CCAPP COUNSELOR
• Dominique MC Dowell, CADC-CAS
• De Marquis MC Henry

• 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 Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.