Individual provider Active NPI

Lisa De la Rue, PH.D.

  • Psychologist
  • San Francisco, CA
National Provider Identifier
1609901446
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35884 Issued in CA
Practice address
2350 Turk Blvd
San Francisco, CA 94118-4340
Phone
(669) 295-5411
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 94026472 CA
Student in an Organized Health Care Education/Training Program 390200000X
Psychologist 103T00000X 35884 CA Primary
Counselor 101Y00000X

Addresses

Primary practice location

2350 Turk Blvd
San Francisco, CA 94118-4340

Mailing address

2130 Fulton St
San Francisco, CA 94117-1080
Phone (669) 295-5411

Other practice location 1

2130 Fulton St
San Francisco, CA 94117-1050
Phone (415) 422-2516

Other practice location 2

902 S Myrtle Ave
second Floor
Monrovia, CA 91016-3427
Phone (626) 357-3258

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

LicenseStateTypeSpecialty
94026472CAMDCounseling Psychologist
35884CAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1609901446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 FULTON ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171080",
            "telephone_number": "669-295-5411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 TURK BLVD",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941184340",
            "telephone_number": "669-295-5411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2130 Fulton St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941171050",
            "country_code": "US",
            "telephone_number": "415-422-2516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "902 S Myrtle Ave",
            "address_2": "second Floor",
            "address_purpose": "LOCATION",
            "city": "Monrovia",
            "state": "CA",
            "postal_code": "910163427",
            "country_code": "US",
            "telephone_number": "626-357-3258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA RUE",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "94026472",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "35884",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.