Vanessa Gantes, PSY. D.
Individual provider Active NPI Psychologist · Corcoran, CA
NPI 1811233778 · NPPES record last updated May 4, 2022
Key facts
- NPI
- 1811233778
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY27992 (CA)
- Practice address
- 4001 King Ave
Corcoran, CA 93212-9611 - Phone
- (559) 992-8800
- NPI assigned
- Dec 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27992 | CA | MD | Psychologist |
| 27992 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corrections and Rehabilitation-Headquarters | Current |
Accepting new patients | |
| CSP-Corcoran | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CA | ||
| Psychologist | 103T00000X | PSY27992 | CA | Yes |
Addresses
Primary practice location
4001 King Ave
Corcoran, CA 93212-9611
Mailing address
5669 N Fresno St Apt 134
Fresno, CA 93710-8307
Phone (831) 998-0136
Other providers in Corcoran, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.