Active NPI
Diane Malnekoff, PHD
- Psychologist
- Santa Rosa, CA
National Provider Identifier
1861595407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY16018
- Practice address
- 509 7TH Street
Santa Rosa, CA 95401 - Phone
- (707) 523-1000
- Fax
- (707) 568-1117
- NPI assigned
- Sep 7, 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 | PSY16018 | CA | Primary |
Addresses
Primary practice location
509 7TH Street
Santa Rosa, CA 95401
Mailing address
509 7TH Street
Santa Rosa, CA 95401
Phone (707) 523-1000
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120118000468 | CA | Practitioner - Clinical Psychologist | 2365619202 | Practice locations: Mill Valley, CA; Santa Rosa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
655 Redwood Hwy
Suite 119
Mill Valley, CA 94941-3009
Phone (415) 924-0860
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16018 | CA | MD | Psychologist |
| 16018 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861595407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 7TH STREET",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95401",
"telephone_number": "707-523-1000",
"fax_number": "707-568-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 7TH STREET",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95401",
"telephone_number": "707-523-1000",
"fax_number": "707-568-1117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALNEKOFF",
"first_name": "DIANE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY16018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.