Bay Area MHC Psychology PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

BAY AREA MHC PSYCHOLOGY PC

Practice address

21 Tamal Vista Blvd Ste 225
Corte Madera, CA 94925-1130

Phone

(415) 233-7990

NPI assigned

Jun 28, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicolas Chu, PSYDNPI 1912339540

Title

Co-Director

Phone

(415) 233-7990

Specialties & licenses 8

Addresses

Other names 1

• Bridge to Bridge Psychotherapy Group Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicolas Chu, PSY.D.

  • Clinical Psychologist
  • Corte Madera, CA
  • NPI 1912339540

  Cognitive & Behavioral

  NPD Authorized official
• Alexis Christine Petrakis, PSY.D.

  • Clinical Psychologist
  • Corte Madera, CA
  • NPI 1215160569

  Clinical

  NPD
• Lauren Lowe, M.S., PSY.D.

  • Psychologist
  • San Francisco, CA
  • NPI 1942672779
  NPD (past)
• Erin Scollin Skiffer, PSY.D.

  • Psychologist
  • Corte Madera, CA
  • NPI 1295083368
  NPD (past)

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

{
    "created_epoch": "1593302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1639796402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 TAMAL VISTA BLVD STE 225",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251130",
            "telephone_number": "415-233-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 TAMAL VISTA BLVD STE 225",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251130",
            "telephone_number": "415-233-7990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2481 Clay St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941151893",
            "country_code": "US",
            "telephone_number": "415-870-1425",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 5th St",
            "address_purpose": "LOCATION",
            "city": "Petaluma",
            "state": "CA",
            "postal_code": "949523042",
            "country_code": "US",
            "telephone_number": "415-233-7990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAY AREA MHC PSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-28",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "CHU",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_title_or_position": "CO-DIRECTOR",
        "authorized_official_telephone_number": "415-233-7990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge to Bridge Psychotherapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sergio Baroni, LCSW
• Scott Barshack, M.D.
• Bass Medical Group
• Carl Ira Baum, MD
• Bay Area Hand Therapy
• Brian Beaudoin, PT
• Alina Belohlavek
• Stefan Benton, MFT
• Omri Berger, M.D.
• Barbara Berman, PSY 15396

• All providers in Corte Madera, CA
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.