Shannon Dubach, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY24793 Issued in CA

Practice address

2041 Bancroft Way Ste 307
Berkeley, CA 94704-1406

Phone

(510) 686-3773

Fax

(510) 649-1133

NPI assigned

Jun 30, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1992967996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 BANCROFT WAY STE 307",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041406",
            "telephone_number": "510-686-3773",
            "fax_number": "510-649-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 BANCROFT WAY STE 307",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041406",
            "telephone_number": "510-686-3773",
            "fax_number": "510-649-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBACH",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY24793",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY24793",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Ernest Driver, CAADE-I
• Frederika Ellen Drosten, I.B.C.L.C, R.N.
• Linda Jean Druschel, PH.D.
• Yi Du
• Jorge Andres Duarte, MSW
• Penny Dublin, LCSW
• Robert Wiley Dubois, LAC
• Carlos Andre Dubose
• Jon Michael Lazaleta Duey
• Matthew Owen Duffett, L.AC.

• Clinical Psychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; 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.