Active NPI
Ivanka Staros, PSYD
- Clinical Psychologist
- Sacramento, CA
National Provider Identifier
1952445520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSB 34677
- Practice address
- 4600 47TH Ave Ste 210
Sacramento, CA 95824-3923 - Phone
- (916) 438-3030
- NPI assigned
- Feb 16, 2007
- Last updated
- Oct 21, 2010
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSB 34677 | CA | Primary |
Addresses
Primary practice location
4600 47TH Ave Ste 210
Sacramento, CA 95824-3923
Mailing address
626 Balboa St
San Francisco, CA 94118-3725
Phone (415) 668-5955
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
| License | State | Type | Specialty |
|---|---|---|---|
| PSB 34677 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287619200000",
"number": "1952445520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 BALBOA ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941183725",
"telephone_number": "415-668-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 47TH AVE STE 210",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958243923",
"telephone_number": "916-438-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAROS",
"first_name": "IVANKA",
"name_prefix": "Ms.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2010-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB 34677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.