Active NPI
Mark Gerald Bender, PH.D.
- Clinical Psychologist
- Cotati, CA
National Provider Identifier
1730332255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY9697
- Practice address
- 204 Mendelssohn CT
Cotati, CA 94931-5378 - Phone
- (707) 794-9337
- NPI assigned
- Oct 28, 2008
- Last updated
- Mar 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY9697 | CA | Primary |
| Psychologist | 103T00000X | PSY 9697 | CA |
Addresses
Primary practice location
204 Mendelssohn CT
Cotati, CA 94931-5378
Mailing address
204 Mendelssohn CT
Cotati, CA 94931-5378
Phone (707) 794-9337
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 9697 | CA | MD | Psychologist |
| 9697 | CA | MD | Neurological Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pasadena Clinical Group, a Psychology Corporation | Psychologist | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychologist
- Pasadena, CA
- NPI 1790213247
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520208000000",
"number": "1730332255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 MENDELSSOHN CT",
"city": "COTATI",
"state": "CA",
"postal_code": "949315378",
"telephone_number": "707-794-9337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 MENDELSSOHN CT",
"city": "COTATI",
"state": "CA",
"postal_code": "949315378",
"telephone_number": "707-794-9337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENDER",
"first_name": "MARK",
"middle_name": "GERALD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-28",
"last_updated": "2018-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY9697",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 9697",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cotati, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.