Jaclyn Mayberry Bauer, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY22799 Issued in CA

Practice address

6400 Canoga Ave
Suite 154
Woodland Hills, CA 91367-2425

Phone

(310) 926-3192

NPI assigned

Sep 18, 2007

Last updated

Jan 1, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Mayberry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262304000000",
    "number": "1467648089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 CANOGA AVE",
            "address_2": "SUITE 154",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672425",
            "telephone_number": "310-926-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 CANOGA AVE",
            "address_2": "SUITE 154",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672425",
            "telephone_number": "310-926-3192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUER",
        "first_name": "JACLYN",
        "middle_name": "MAYBERRY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-18",
        "last_updated": "2010-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "MAYBERRY",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marionbeth J Bates
• Lea Marie Bathon
• Irma Batriz
• Kylie Battiata
• Paris Debonae Batts
• Carolyn Lee Baum, MSW, LCSW
• Dennis Bautista
• Jose Santos Bautista, PHARMD
• Kenneth Bautista, RBT
• Portia Bautista

• Clinical Psychologist in Woodland Hills, CA
• Providers in Woodland Hills, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.