Jennifer A Banta, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20473 Issued in CA

Practice address

815 Buena Vista Ave W
Walden House-Hafc Dual Recovery Program
San Francisco, CA 94117-4108

Phone

(415) 558-4206

Fax

(415) 558-4235

NPI assigned

May 7, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1629337944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 BUENA VISTA AVE W",
            "address_2": "WALDEN HOUSE-HAFC DUAL RECOVERY PROGRAM",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941174108",
            "telephone_number": "415-558-4206",
            "fax_number": "415-558-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 BUENA VISTA AVE W",
            "address_2": "WALDEN HOUSE-HAFC DUAL RECOVERY PROGRAM",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941174108",
            "telephone_number": "415-558-4206",
            "fax_number": "415-558-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTA",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20473",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Banks
• Margaret Ann Bannerman, M.D.
• Jerice Kent Banola
• Houmpheng Banouvong
• Danesh Bansal, MD
• Hyginie L Banting
• Gilbert Banuelos Jr.
• Joel Banuelos
• Stephen Michael Banuelos, LCSW
• Peter Banys, M.D., M.SC.

• Clinical Psychologist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; 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.