Individual provider Active NPI

Andrea Marie Pinkerton, PSY.D.

  • Clinical Psychologist
  • Novato, CA
National Provider Identifier
1447480140
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 26113 Issued in CA
Practice address
505 San Marin Dr
Ste A150
Novato, CA 94945-1357
Phone
(415) 686-7364
Fax
(949) 862-8024
NPI assigned
Jul 16, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 26113 CA Primary

Addresses

Primary practice location

505 San Marin Dr
Ste A150
Novato, CA 94945-1357

Mailing address

12335 N Humphreys Way
Boise, ID 83714-9304
Phone (415) 686-7364

Other practice location 1

12335 N Humphreys Way
Boise, ID 83714-9304
Phone (415) 686-7364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140307000435 CA Practitioner - Clinical Psychologist 0547490062 Practice locations: Novato, CA
I20210722001385 ID Practitioner - Clinical Psychologist 0547490062 Practice locations: Boise, ID

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12335 N Humphreys Way
Boise, ID 83714-9304
Phone (415) 686-7364

505 San Marin Dr
Suite A150
Novato, CA 94945-1357
Phone (415) 686-7364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 26113CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1447480140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12335 N HUMPHREYS WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837149304",
            "telephone_number": "415-686-7364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 SAN MARIN DR",
            "address_2": "STE A150",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949451357",
            "telephone_number": "415-686-7364",
            "fax_number": "949-862-8024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12335 N Humphreys Way",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837149304",
            "country_code": "US",
            "telephone_number": "415-686-7364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PINKERTON",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-16",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 26113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.