NPIMap

Organization Active NPI

Neuropsychological Assoc of Ca-a Professional Psychological Corp

  • Clinical Neuropsychologist
  • Santa Rosa, CA
National Provider Identifier
1508004540
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
23205 Issued in CA
Legal business name
NEUROPSYCHOLOGICAL ASSOC OF CA-A PROFESSIONAL PSYCHOLOGICAL CORP
Practice address
1260 N Dutton Ave
Ste 225
Santa Rosa, CA 95401-4659
Phone
(707) 526-5424
Fax
(707) 526-5900
NPI assigned
Jan 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

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

Authorized official

Name
Dr. Carolyn Frances Crimmins, PSY.D.
Title
Provider
Phone
(707) 526-5424

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 23205 CA Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1260 N Dutton Ave
Ste 225
Santa Rosa, CA 95401-4659

Mailing address

1260 N Dutton Ave
Ste 225
Santa Rosa, CA 95401-4659
Phone (707) 526-5424

Other identifiers 1

IdentifierTypeStateIssuer
PSY23205OtherCAPSYCHOLOGIST LICENSE

Other names 1

  • Neuropsychological Associates Of CA Doing business as

National Provider Directory

National Provider Directory

Locations

1260 N Dutton Ave
Ste 225
Santa Rosa, CA 95401
Phone (707) 340-3650

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573776000000",
    "number": "1508004540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 N DUTTON AVE",
            "address_2": "STE 225",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014659",
            "telephone_number": "707-526-5424",
            "fax_number": "707-526-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 N DUTTON AVE",
            "address_2": "STE 225",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014659",
            "telephone_number": "707-526-5424",
            "fax_number": "707-526-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROPSYCHOLOGICAL ASSOC OF CA-A PROFESSIONAL PSYCHOLOGICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-29",
        "last_updated": "2019-11-15",
        "status": "A",
        "authorized_official_last_name": "CRIMMINS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "FRANCES",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "707-526-5424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "23205",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE",
            "identifier": "PSY23205",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neuropsychological Associates Of CA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Neuropsychological Associates Of CA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; 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.