Active NPI
Jennifer Stewart
- Psychologist
- Larkspur, CA
National Provider Identifier
1407404049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY34555
- Practice address
- 464 Old Quarry Rd N
Larkspur, CA 94939-2228 - Phone
- (703) 638-3033
- NPI assigned
- Aug 27, 2019
- Last updated
- Sep 29, 2023
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY34555 | CA | Primary |
Addresses
Primary practice location
464 Old Quarry Rd N
Larkspur, CA 94939-2228
Mailing address
464 Old Quarry Rd N
Larkspur, CA 94939-2228
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34555 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California Psychology Center | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Mountain View, CA
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1407404049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 OLD QUARRY RD N",
"city": "LARKSPUR",
"state": "CA",
"postal_code": "949392228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 OLD QUARRY RD N",
"city": "LARKSPUR",
"state": "CA",
"postal_code": "949392228",
"telephone_number": "703-638-3033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-27",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY34555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Larkspur, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.