Active NPI
Theresa Phillips, PHD
- Psychologist
- Richmond, CA
National Provider Identifier
1932136108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 19723
- Practice address
- 115 E Richmond Ave
Richmond, CA 94801-4034 - Phone
- (510) 237-6865
- NPI assigned
- Jun 26, 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 | PSY 19723 | CA | Primary |
Addresses
Primary practice location
115 E Richmond Ave
Richmond, CA 94801-4034
Mailing address
1 Baywood Ave
Suite 7
San Mateo, CA 94402-1537
Phone (650) 344-6961
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY19723 | Other | CA | STATE LICENSE |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 19723 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932136108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BAYWOOD AVE",
"address_2": "SUITE 7",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944021537",
"telephone_number": "650-344-6961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 E RICHMOND AVE",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948014034",
"telephone_number": "510-237-6865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "THERESA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 19723",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PSY19723",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.