Active NPI
Scott Gordon, PSYD
- Psychologist
- Berkeley, CA
National Provider Identifier
1447020243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY36173
- Practice address
- 2915 Martin Luther King Jr Way
Berkeley, CA 94703-2133 - Phone
- (510) 485-9655
- NPI assigned
- Jan 3, 2024
- Reactivated
- Oct 24, 2025
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY36173 | CA | Primary |
Addresses
Primary practice location
2915 Martin Luther King Jr Way
Berkeley, CA 94703-2133
Mailing address
1442A Walnut St # 326
Berkeley, CA 94709-1405
Phone (510) 485-9655
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 |
|---|---|---|---|
| PSY36173 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1447020243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1442A WALNUT ST # 326",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091405",
"telephone_number": "510-485-9655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2915 MARTIN LUTHER KING JR WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947032133",
"telephone_number": "510-485-9655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "SCOTT",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-03",
"last_updated": "2025-10-24",
"certification_date": "2025-10-24",
"deactivation_date": "2024-01-09",
"reactivation_date": "2025-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY36173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.