Active NPI
Kimberly Bausback
- Clinical Psychologist
- San Mateo, CA
National Provider Identifier
1538881982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33564
- Practice address
- 116 E 25TH Ave Ste C
San Mateo, CA 94403-2596 - Phone
- (650) 336-0443
- NPI assigned
- Sep 13, 2022
- 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 | 33564 | CA | Primary |
Addresses
Primary practice location
116 E 25TH Ave Ste C
San Mateo, CA 94403-2596
Mailing address
116 E 25TH Ave Ste C
San Mateo, CA 94403-2596
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1538881982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 E 25TH AVE STE C",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 E 25TH AVE STE C",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032596",
"telephone_number": "650-336-0443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUSBACK",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-13",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "33564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.