Active NPI
R Scott Sullender, PHD
- Psychologist
- San Anselmo, CA
National Provider Identifier
1427169648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY8931
- Practice address
- 15 Austin
San Anselmo, CA 94960-2925 - Phone
- (415) 258-6652
- Fax
- (415) 256-9801
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- 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 | PSY8931 | CA | Primary |
Addresses
Primary practice location
15 Austin
San Anselmo, CA 94960-2925
Mailing address
105 Seminary Rd
San Anselmo, CA 94960-2925
Phone (415) 258-6652
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PB0089310 | Medicaid | CA |
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 |
|---|---|---|---|
| PSY8931 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427169648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 SEMINARY RD",
"city": "SAN ANSELMO",
"state": "CA",
"postal_code": "949602925",
"telephone_number": "415-258-6652",
"fax_number": "415-256-9801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 AUSTIN",
"city": "SAN ANSELMO",
"state": "CA",
"postal_code": "949602925",
"telephone_number": "415-258-6652",
"fax_number": "415-256-9801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLENDER",
"first_name": "R",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY8931",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PB0089310",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Anselmo, CA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.