Active NPI
Ilysa Shari Goldblatt, PSYD
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1962924514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29101
- Practice address
- 3569 Sacramento St # 310
San Francisco, CA 94118-1866 - Phone
- (415) 518-6202
- NPI assigned
- Jul 14, 2017
- Last updated
- Jul 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 | 29101 | CA | Primary |
Addresses
Primary practice location
3569 Sacramento St # 310
San Francisco, CA 94118-1866
Mailing address
2268 Camino Ramon
San Ramon, CA 94583-1353
Phone (415) 518-6202
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 |
|---|---|---|---|
| 29101 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499990400000",
"number": "1962924514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2268 CAMINO RAMON",
"city": "SAN RAMON",
"state": "CA",
"postal_code": "945831353",
"telephone_number": "415-518-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3569 SACRAMENTO ST # 310",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941181866",
"telephone_number": "415-518-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBLATT",
"first_name": "ILYSA",
"middle_name": "SHARI",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-14",
"last_updated": "2017-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.