Active NPI
Marjorie Gans Walters, PHD
- Psychologist
- San Rafael, CA
National Provider Identifier
1992719710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY5200
- Practice address
- 711 D Street
Suite 204
San Rafael, CA 94901-3704 - Phone
- (415) 457-9192
- Fax
- (415) 457-9192
- NPI assigned
- Jul 28, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY5200 | CA | Primary |
Addresses
Primary practice location
711 D Street
Suite 204
San Rafael, CA 94901-3704
Mailing address
711 D Street
Suite 204
San Rafael, CA 94901-3704
Phone (415) 457-9192
Other names 1
- Dr. Marjorie Gans
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 |
|---|---|---|---|
| PSY5200 | CA | MD | Psychologist |
| 5200 | CA | MD | Emotionally Disturbed Childrens' Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992719710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 D STREET",
"address_2": "SUITE 204",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013704",
"telephone_number": "415-457-9192",
"fax_number": "415-457-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 D STREET",
"address_2": "SUITE 204",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013704",
"telephone_number": "415-457-9192",
"fax_number": "415-457-9192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "MARJORIE",
"middle_name": "GANS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY5200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARJORIE",
"last_name": "GANS",
"prefix": "DR.",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Rafael, 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.