Individual provider Active NPI

Mary Deyo, PSY.D.

  • Psychologist
  • Santa Rosa, CA
National Provider Identifier
1679897219
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
23285 Issued in CA
Practice address
725 Farmers LN Ste 15
Santa Rosa, CA 95405-6743
Phone
(707) 331-2618
NPI assigned
Mar 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 23285 CA Primary

Addresses

Primary practice location

725 Farmers LN Ste 15
Santa Rosa, CA 95405-6743

Mailing address

725 Farmers LN Ste 15
Santa Rosa, CA 95405-6743
Phone (707) 331-2618

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Psych Strategies Inc a Psychological Corp Psychologist PastSince Aug 1, 2002 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1679897219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 FARMERS LN STE 15",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056743",
            "telephone_number": "707-331-2618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 FARMERS LN STE 15",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056743",
            "telephone_number": "707-331-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEYO",
        "first_name": "MARY",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-25",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "23285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; 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.