Active NPI
Jennifer Douglas, PHD
- Psychologist
- Palo Alto, CA
National Provider Identifier
1386167500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 29318
- Practice address
- 401 Quarry Rd
Palo Alto, CA 94304-1419 - Phone
- (650) 723-6308
- NPI assigned
- Jul 19, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29318 | CA | |
| Psychologist | 103T00000X | 29318 | CA | Primary |
Addresses
Primary practice location
401 Quarry Rd
Palo Alto, CA 94304-1419
Mailing address
401 Quarry Rd
Palo Alto, CA 94304-1419
Phone (650) 723-6308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2026 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29318 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1386167500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 QUARRY RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041419",
"telephone_number": "650-723-6308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 QUARRY RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041419",
"telephone_number": "650-723-6308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "JENNIFER",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29318",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "29318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.