Active NPI
Chandra Ghosh Ippen, PH.D.
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1376741389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY17759
- Practice address
- 1001 Potrero Ave
RM. 7M
San Francisco, CA 94110-3518 - Phone
- (415) 206-5612
- Fax
- (415) 206-8942
- NPI assigned
- Jul 11, 2007
- Sex
- Female
- Sole proprietor
- No
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 | PSY17759 | CA | Primary |
Addresses
Primary practice location
1001 Potrero Ave
RM. 7M
San Francisco, CA 94110-3518
Mailing address
PO Box 7464
San Francisco, CA 94120-7464
Phone (415) 206-3103
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 |
|---|---|---|---|
| PSY17759 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1376741389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7464",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941207464",
"telephone_number": "415-206-3103",
"fax_number": "415-206-3872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 POTRERO AVE",
"address_2": "RM. 7M",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941103518",
"telephone_number": "415-206-5612",
"fax_number": "415-206-8942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHOSH IPPEN",
"first_name": "CHANDRA",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-11",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY17759",
"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 Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.