NPIMap

Individual provider Active NPI

Justin Tarrance Gibson

  • Psychologist
  • San Francisco, CA
National Provider Identifier
1922234525
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
29025 Issued in CA
Practice address
500 Parnassus Ave RM 5
San Francisco, CA 94143-2203
Phone
(415) 476-1281
NPI assigned
Jun 9, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 29025 CA
Clinical Psychologist 103TC0700X 29025 CA
Counseling Psychologist 103TC1900X 29025 CA
Health Service Psychologist 103TH0100X 29025 CA
Group Psychotherapy Psychologist 103TP2701X 29025 CA
Student in an Organized Health Care Education/Training Program 390200000X
Psychologist 103T00000X 29025 CA Primary

Addresses

Primary practice location

500 Parnassus Ave RM 5
San Francisco, CA 94143-2203

Mailing address

2222 Bancroft Way
University of California, Berkeley
Berkeley, CA 94720-4301
Phone (256) 337-9064

Other practice location 1

2222 Bancroft Way
University of California, Berkeley
Berkeley, CA 94720-4301
Phone (256) 337-9064

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

LicenseStateTypeSpecialty
29025CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
UCSF Student Health and Counseling Services PastSince Feb 19, 2023 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1922234525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 BANCROFT WAY",
            "address_2": "UNIVERSITY OF CALIFORNIA, BERKELEY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947204301",
            "telephone_number": "256-337-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PARNASSUS AVE RM 5",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432203",
            "telephone_number": "415-476-1281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 Bancroft Way",
            "address_2": "University of California, Berkeley",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947204301",
            "country_code": "US",
            "telephone_number": "256-337-9064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JUSTIN",
        "middle_name": "TARRANCE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-09",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "29025",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "29025",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "29025",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "CA",
            "license": "29025",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "29025",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "29025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.