NPIMap

Organization Active NPI

Kelley Bryan Gin, PSYD

  • Clinical Psychologist
  • Berkeley, CA
National Provider Identifier
1972072023
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
KELLEY BRYAN GIN, PSYD
Practice address
2711 Alcatraz Ave Ste 2
Berkeley, CA 94705-2726
Phone
(510) 219-7091
NPI assigned
Nov 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Authorized official

Name
Dr. Kelley Gin, PSYDNPI 1194870949
Title
Owner
Phone
(510) 219-7091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

2711 Alcatraz Ave Ste 2
Berkeley, CA 94705-2726

Mailing address

2711 Alcatraz Ave Ste 2
Berkeley, CA 94705-2726
Phone (510) 219-7091

National Provider Directory

National Provider Directory

Locations

2711 Alcatraz Ave
Ste 2
Berkeley, CA 94705
Phone (510) 219-7091

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1972072023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 ALCATRAZ AVE STE 2",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052726",
            "telephone_number": "510-219-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 ALCATRAZ AVE STE 2",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052726",
            "telephone_number": "510-219-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY BRYAN GIN, PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-19",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "GIN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-219-7091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.