Active NPI
Kelly Marie Paquette, PSY.D.
- Clinical Psychologist
- Corte Madera, CA
National Provider Identifier
1447308028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY25608
- Practice address
- 100 Meadowcreek Dr Ste 115
Corte Madera, CA 94925-1230 - Phone
- (415) 794-2391
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY25608 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
100 Meadowcreek Dr Ste 115
Corte Madera, CA 94925-1230
Mailing address
198 Oriole Cir
Novato, CA 94949-6678
Phone (415) 794-2391
Other practice location 1
788C Vista Ct
San Francisco, CA 94129-2276
Phone (510) 439-6045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2021 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25608 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1447308028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "198 ORIOLE CIR",
"city": "NOVATO",
"state": "CA",
"postal_code": "949496678",
"telephone_number": "415-794-2391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MEADOWCREEK DR STE 115",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251230",
"telephone_number": "415-794-2391"
}
],
"practiceLocations": [
{
"address_1": "788C Vista Ct",
"address_purpose": "LOCATION",
"city": "San Francisco",
"state": "CA",
"postal_code": "941292276",
"country_code": "US",
"telephone_number": "510-439-6045",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAQUETTE",
"first_name": "KELLY",
"middle_name": "MARIE",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY25608",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corte Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.