Jaime Nisenbaum, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 23623 Issued in CA

Practice address

711 D St Ste 201
San Rafael, CA 94901-3704

Phone

(415) 516-0797

NPI assigned

Sep 16, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284595200000",
    "number": "1902114523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LONGVIEW AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602325",
            "telephone_number": "415-516-0797",
            "fax_number": "415-456-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 D ST STE 201",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013704",
            "telephone_number": "415-516-0797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISENBAUM",
        "first_name": "JAIME",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 23623",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 23623",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY 23623",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Lynn Nickel, M.D.
• Monica Nicol
• Patricia A Nicol, M.D.
• Gary S. Nicolaisen, MD
• Claire Nilsen, CCMA
• Nancy Keiko Nishimura-Garvin, MFT INTERN
• Brian Shuhei Nishinaga, M.D.
• Ashley Dean Nisley, PHARMD
• Susan J Nissim
• Mervyn Njinyi

• Psychologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.