Active NPI
Natasha Lynn Quackenbush, PSY.D.
- Clinical Psychologist
- Antioch, CA
National Provider Identifier
1710024302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18753
- Practice address
- 3454 Hillcrest Ave
Antioch, CA 94531-8238 - Phone
- (925) 777-6359
- Fax
- (925) 777-6363
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18753 | CA | Primary |
Addresses
Primary practice location
3454 Hillcrest Ave
Antioch, CA 94531-8238
Mailing address
3454 Hillcrest Ave
Antioch, CA 94531-8238
Phone (925) 777-6359
Other names 1
- Dr. Natasha Lynn Coleman
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18753 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1710024302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3454 HILLCREST AVE",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318238",
"telephone_number": "925-777-6359",
"fax_number": "925-777-6363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3454 HILLCREST AVE",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318238",
"telephone_number": "925-777-6359",
"fax_number": "925-777-6363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUACKENBUSH",
"first_name": "NATASHA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2022-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18753",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "The Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "3454 Hillcrest Ave",
"city": "Antioch",
"state": "CA",
"country_code": "US",
"postal_code": "945318238",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "NATASHA",
"last_name": "COLEMAN",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "PSY.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.