Active NPI
Ron Destefano, PH.D.
- Clinical Psychologist
- Mill Valley, CA
National Provider Identifier
1417173519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY7013
- Practice address
- 342 Laverne Ave
Mill Valley, CA 94941-3434 - Phone
- (415) 383-3489
- Fax
- (415) 383-3489
- NPI assigned
- Apr 17, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 | PSY7013 | CA | Primary |
Addresses
Primary practice location
342 Laverne Ave
Mill Valley, CA 94941-3434
Mailing address
342 Laverne Ave
Mill Valley, CA 94941-3434
Phone (415) 383-3489
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417173519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "342 LAVERNE AVE",
"city": "MILL VALLEY",
"state": "CA",
"postal_code": "949413434",
"telephone_number": "415-383-3489",
"fax_number": "415-383-3489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "342 LAVERNE AVE",
"city": "MILL VALLEY",
"state": "CA",
"postal_code": "949413434",
"telephone_number": "415-383-3489",
"fax_number": "415-383-3489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "RON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY7013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mill Valley, CA
- Dba Child Development Center of Marin (DBA Child Development Center)
- Amanda Decker
- Joshua Ari Deitch, DC
- Ma Pilar Francezka Violanda Depaz, COTA/L
- John Deri, M.D.
- Maryse Devost-Varriale, RPH
- Cara Marie Devries, CARA DEVRIES
- Cooper Differding, D.D.S
- Janet Croce Disanto, MFT
- Disick Dental Corporation (Evan S. Disick, D.D.S.)
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; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.