Active NPI
Edie Walden, PH.D.
- Clinical Psychologist
- San Rafael, CA
National Provider Identifier
1508089798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18112
- Practice address
- 711 D St Ste 117
San Rafael, CA 94901-3703 - Phone
- (415) 461-4322
- Fax
- (415) 461-4322
- NPI assigned
- Apr 10, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18112 | CA | Primary |
Addresses
Primary practice location
711 D St Ste 117
San Rafael, CA 94901-3703
Mailing address
336 Bon Air Shopping Ctr # 519
Greenbrae, CA 94904-3017
Phone (415) 461-4322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18112 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508089798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "336 BON AIR SHOPPING CTR # 519",
"city": "GREENBRAE",
"state": "CA",
"postal_code": "949043017",
"telephone_number": "415-461-4322",
"fax_number": "415-461-4322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 D ST STE 117",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013703",
"telephone_number": "415-461-4322",
"fax_number": "415-461-4322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDEN",
"first_name": "EDIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.