Active NPI
Michelina Gautieri, PSY.D.
- Psychologist
- San Rafael, CA
National Provider Identifier
1841211976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY13458
- Practice address
- 3230 Kerner Blvd
San Rafael, CA 94901-4840 - Phone
- (415) 473-5053
- Fax
- (415) 473-3080
- NPI assigned
- Jul 22, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY13458 | CA | Primary |
Addresses
Primary practice location
3230 Kerner Blvd
San Rafael, CA 94901-4840
Mailing address
131 Poplar St
Berkeley, CA 94708-1325
Phone (510) 526-4853
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY13458 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307059200000",
"number": "1841211976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 POPLAR ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947081325",
"telephone_number": "510-526-4853",
"fax_number": "415-473-3080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3230 KERNER BLVD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949014840",
"telephone_number": "415-473-5053",
"fax_number": "415-473-3080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUTIERI",
"first_name": "MICHELINA",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-22",
"last_updated": "2011-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY13458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.