Individual provider Active NPI

Jennifer Casper, PSYD

  • Clinical Psychologist
  • Berkeley, CA
National Provider Identifier
1710303102
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
34075 Issued in CA
Practice address
1749 Martin Luther King Jr Way
Berkeley, CA 94709-2139
Phone
(510) 841-8484
NPI assigned
Mar 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Community Health Worker 172V00000X
Clinical Psychologist 103TC0700X 34075 CA Primary

Addresses

Primary practice location

1749 Martin Luther King Jr Way
Berkeley, CA 94709-2139

Mailing address

308 Broadmoor Blvd
San Leandro, CA 94577-1946
Phone (925) 984-7036

Other names 1

  • Jennifer Nibel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230811002251 CA Practitioner - Clinical Psychologist 6204298904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Berkeley Therapy InstituteGroup PAC ID 2264414283, 13 clinicians

Practice addresses (Care Compare)

1749 Martin Luther King Jr Way
Berkeley, CA 94709-2139
Phone 51084184841130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34075CAMDChiropractor

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": "1394409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1710303102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 BROADMOOR BLVD",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945771946",
            "telephone_number": "925-984-7036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 MARTIN LUTHER KING JR WAY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947092139",
            "telephone_number": "510-841-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASPER",
        "first_name": "JENNIFER",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-10",
        "last_updated": "2023-03-17",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "34075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "NIBEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.