Active NPI
Ian Donnelly Faerstein, PSY.D.
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1811246457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY28785
- Practice address
- 2428 Dwight Way
Ste 3
Berkeley, CA 94704-3503 - Phone
- (510) 296-3090
- NPI assigned
- Aug 29, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY28785 | CA | Primary |
Addresses
Primary practice location
2428 Dwight Way
Ste 3
Berkeley, CA 94704-3503
Mailing address
2428 Dwight Way
Ste 3
Berkeley, CA 94704-3503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241016002497 | NC | Practitioner - Clinical Psychologist | 5991089823 | Practice locations: Carrboro, NC |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
205 Lloyd St
Suite 204
Carrboro, NC 27510-1883
Phone (510) 296-3090
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY28785 | CA | MD | Clinical Psychologist |
| 6591 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635552000000",
"number": "1811246457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2428 DWIGHT WAY",
"address_2": "STE 3",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947043503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2428 DWIGHT WAY",
"address_2": "STE 3",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947043503",
"telephone_number": "510-296-3090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAERSTEIN",
"first_name": "IAN",
"middle_name": "DONNELLY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-29",
"last_updated": "2021-10-30",
"certification_date": "2021-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY28785",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.