Susan Lake, PSYD

Primary specialty

Rehabilitation CounselorTaxonomy code 225C00000X

Practice address

1330 Lincoln Ave Ste 201
San Rafael, CA 94901-2142

Phone

(415) 459-5999

NPI assigned

Sep 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Community Institute for Psychotherapy

  • Voluntary or Charitable Agency
  • San Rafael, CA
  • NPI 1760403794
  NPD (past)
• Community Institute for Psychotherapy

  • Community/Behavioral Health Agency
  • San Rafael, CA
  • NPI 1780995258
  NPD (past)

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

{
    "created_epoch": "1315612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1962784488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 LINCOLN AVE STE 201",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012142",
            "telephone_number": "415-459-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 LINCOLN AVE STE 201",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012142",
            "telephone_number": "415-459-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "SUSAN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-10",
        "last_updated": "2020-12-17",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikoyan Lagrimas, DDS
• Jennifer B. Lai, M.SC., PHARM.D.
• Phuong Lai
• Shih-Ni Lai, OTR/L, CLT
• Stephanie Claire Lai
• Anita Lam
• Annie Lam, RDH
• Jamie Kim Lam
• Viet M. Lam, MD
• Jessica Nicole Lamb

• Rehabilitation Counselor in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Rehabilitation Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.

Verify at the official NPI Registry.