Maryam Hafezi, MS,MA

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Practice address

7668 Frederiksen LN
Dublin, CA 94568-1651

Phone

(925) 556-0749

NPI assigned

Dec 12, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1548405996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7668 FREDERIKSEN LN",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945681651",
            "telephone_number": "925-556-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7668 FREDERIKSEN LN",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945681651",
            "telephone_number": "925-556-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAFEZI",
        "first_name": "MARYAM",
        "name_prefix": "Ms.",
        "credential": "MS,MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-12",
        "last_updated": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "300 Pullman St",
            "city": "Livermore",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945519756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Yarizel Gutierrez
• Elias Guzman
• Gema Guzman
• Chris S Ha, D.D.S
• Gerisha Nicole Hackett
• Emma Hall Haines
• Haley Hall
• Lindsey Hall
• Tyler Hall
• Hallway Healthcare

• Cognitive & Behavioral Psychologist in Dublin, CA
• Providers in Dublin, CA by specialty
• Cognitive & Behavioral Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.