Maryann Elizabeth Pellino-Benner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12726 Issued in CA

Practice address

106 San Jose Ave
Pacifica, CA 94044-2700

Phone

(650) 355-9528

Fax

(650) 355-1054

NPI assigned

Jun 8, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Maryann E. Pellino Benner Professional 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": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1497135248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SAN JOSE AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940442700",
            "telephone_number": "650-355-9528",
            "fax_number": "650-355-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SAN JOSE AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940442700",
            "telephone_number": "650-355-9528",
            "fax_number": "650-355-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLINO-BENNER",
        "first_name": "MARYANN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-08",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12726",
            "primary": true
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": "CA",
            "license": "PSY12726",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYANN",
            "last_name": "PELLINO BENNER",
            "middle_name": "E.",
            "prefix": "DR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alicia Marie Pastor, M.S. CCC-SLP
• Kathryn Denise Patt
• Maryanne A Patton, CMT#1589
• Claire Marie Pearson, M.S., CCC-SLP
• Manuel Rizvend Pecana Pecana
• Stephanie Elliott Perez, MFT
• Ashton Renee Perroni, ND
• Physical Sarah-Py
• Andrea Polk, PH D
• Portillo Chiropractic Inc.

• Clinical Psychologist in Pacifica, CA
• Providers in Pacifica, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.