Alexandra Nicole Weaverling, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSB94025519 Issued in CA

Practice address

1010 Grayson St Ste 3
Berkeley, CA 94710-2611

Phone

(415) 475-9355

NPI assigned

Jun 4, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Wise Mind Institute, a Psychological Corporation

  • Psychologist
  • Redwood City, CA
  • NPI 1174990360
  NPD (past)

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

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1417524935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 VETERANS BLVD STE 204",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631419",
            "telephone_number": "415-475-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 GRAYSON ST STE 3",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947102611",
            "telephone_number": "415-475-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVERLING",
        "first_name": "ALEXANDRA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSB94025519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED PSYCHOLOGICAL ASSISTANT",
            "identifier": "PSB94025519",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Watts
• Amy Waxman
• Elinor Waxman, M.S.
• Tess Waxman
• Nicholas Alan Weathersby, PSY.D.
• Audrey H Webb, MSW
• Mikaela Dalia Webb, RN
• Michael George Weber, PH. D.
• Robin Ann Weber
• Webster Orthopaedic Medical Group, Apc

• Clinical Psychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; 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.