Active NPI
Theresa Gannon, PH.D.
- Clinical Neuropsychologist
- Sacramento, CA
National Provider Identifier
1548243413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY16008
- Practice address
- 2825 50TH St
Ucdhs- Mind Institute
Sacramento, CA 95817-2308 - Phone
- (916) 703-0290
- NPI assigned
- Nov 23, 2005
- Last updated
- Feb 22, 2011
- Sex
- Female
- Sole proprietor
- No
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 Neuropsychologist | 103G00000X | PSY16008 | CA | Primary |
Addresses
Primary practice location
2825 50TH St
Ucdhs- Mind Institute
Sacramento, CA 95817-2308
Mailing address
2825 50TH St
Ucdhs- Mind Institute
Sacramento, CA 95817-2308
Phone (916) 703-0290
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY16008 | Other | CA | PSYCHOLOGIST LICENSE # |
| GR002104M | Other | CA | MEDI-CAL GROUP NUMBER |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16008 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298332800000",
"number": "1548243413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2825 50TH ST",
"address_2": "UCDHS- MIND INSTITUTE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958172308",
"telephone_number": "916-703-0290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2825 50TH ST",
"address_2": "UCDHS- MIND INSTITUTE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958172308",
"telephone_number": "916-703-0290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "THERESA",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-23",
"last_updated": "2011-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY16008",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE #",
"identifier": "PSY16008",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL GROUP NUMBER",
"identifier": "GR002104M",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.