Kelly H Werner, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY21858 Issued in CA

Practice address

108 Cazneau Ave
Sausalito, CA 94965-1817

Phone

(510) 847-5127

NPI assigned

Aug 1, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Aug 17, 2024 through Aug 17, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1596240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596240000000",
    "number": "1568072973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CAZNEAU AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651817",
            "telephone_number": "510-847-5127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CAZNEAU AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651817",
            "telephone_number": "510-847-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERNER",
        "first_name": "KELLY",
        "middle_name": "H",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-01",
        "last_updated": "2020-08-01",
        "certification_date": "2020-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY21858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sausalito",
            "affiliation": "N",
            "endpointDescription": "Home",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "108 Cazneau Ave",
            "city": "Sausalito",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949651817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cheryl Ann Vander Waal, MSW
• Maria Guadalupe Villanueva
• Shirley Wantland
• Elizabeth Wantuch, PSY.D.
• Rebecca A Ward, LMFT
• Leslie C West, MD
• Suzanne L Westphal, MD
• Hollynn Frances Wilcox, LMFT
• Shannon Wozniak, N.P.
• Yes Health Inc.

• Psychologist in Sausalito, CA
• Providers in Sausalito, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.