Active NPI
Jacqueline Bunker Persons
- Cognitive & Behavioral Psychologist
- Oakland, CA
National Provider Identifier
1447567417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- PSY7275
- Practice address
- 5435 College Ave
Suite 102
Oakland, CA 94618-1598 - Phone
- (510) 652-4455
- Fax
- (510) 380-2988
- NPI assigned
- Sep 10, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY7275 | CA | Primary |
Addresses
Primary practice location
5435 College Ave
Suite 102
Oakland, CA 94618-1598
Mailing address
5625 College Ave
Suite 215
Oakland, CA 94618-1599
Phone (510) 992-4040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2014 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY7275 | CA | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459987200000",
"number": "1447567417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5625 COLLEGE AVE",
"address_2": "SUITE 215",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181599",
"telephone_number": "510-992-4040",
"fax_number": "888-975-9811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5435 COLLEGE AVE",
"address_2": "SUITE 102",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181598",
"telephone_number": "510-652-4455",
"fax_number": "510-380-2988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSONS",
"first_name": "JACQUELINE",
"middle_name": "BUNKER",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-10",
"last_updated": "2016-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "CA",
"license": "PSY7275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.