Jennifer Fan, PSY.D., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

47184 Issued in CA

Practice address

307 S B St
San Mateo, CA 94401-4053

Phone

(800) 496-3019

NPI assigned

Nov 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Izzo Marriage & Family Therapy PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Mateo, CA
  • NPI 1518557552
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1841366804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S B ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944014053",
            "telephone_number": "310-425-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S B ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944014053",
            "telephone_number": "800-496-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "47184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Peter Fagin, D.M.D., M.D.
• Richard Agnew Fagin, DDS
• Briana T Fair
• Galan Falakfarsa
• Family Service Agency of San Mateo County
• Ki Wi Fan
• Li-Ping Fan, RN
• Amiame Vai Fanaika
• Aikman Fang
• Laureen Ann Fanucchi Racuf, CMT

• Marriage & Family Therapist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.