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DR. STACEY NELSON CLEMENCEAU PH.D.
NPI 1265594113
Psychologist - Clinical in San Rafael, CA

Active since December 15, 2006PECOS Enrolled
820 LAS GALLINAS AVE, SAN RAFAEL, CA 94903(415) 444-3522(415) 444-3019 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Stacey Nelson Clemenceau Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. STACEY NELSON CLEMENCEAU PH.D. (NPI 1265594113) is an individual clinical provider in San Rafael, California, licensed in California (PSY16162) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1265594113
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. STACEY NELSON CLEMENCEAUCredential: PH.D.
Location Address820 LAS GALLINAS AVESan Rafael, CA 94903-3410
Mailing Address820 Las Gallinas AveSan Rafael, CA 94903-3410 · (415) 444-3522 · Fax (415) 444-3019
Phone(415) 444-3522
Fax(415) 444-3019
Sole ProprietorYes
Enumeration DateDecember 15, 2006
Last NPPES UpdateFebruary 11, 2022
✔ NPI 1265594113 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · PSY16162
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
820 LAS GALLINAS AVE, San Rafael, CA 94903
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Other Names 1

Former Name (1)Dr. Stacey Nelson Ph.d.

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Stacey Nelson Clemenceau Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Stacey Clemenceau reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
11 mi
Internal Medicine
901 NEVIN
Richmond, CA 94801
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1235226531 (510) 307-1555

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94903 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$202.63 typical visit price
range $69.07 – $202.63
Typical copayment $50.65 (range $17.26 – $50.65)
Most-billed visit code 99205
Established Patient
$119.61 typical visit price
range $23.44 – $166.64
Typical copayment $29.90 (range $5.86 – $41.66)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LESLIE FRANCES CHATHAM PH.D.
Psychologist (Clinical)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3522
DR. ALI NAVARRO PH.D.
Psychologist
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3522
DR. DAVID LEH-SHENG HUANG M.D.
Psychiatry & Neurology (Psychiatry)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-2000
MARGARET LEVENTER L..C.S.W.
Social Worker (Clinical)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3032
DR. RALPH JAMES LAMSON PH.D.
Psychologist (Addiction (Substance Use Disorder))
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3531
DR. SUSAN ANN DYER PSY.D.
Psychologist (Clinical)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3512
DR. MICHAEL FRED HOYT PH.D.
Psychologist (Clinical)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3073
DR. CHRISTINE HOM PH.D.
Psychologist (Clinical)
820 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Marin County (415) 444-3522

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacey Clemenceau's NPI number?

The NPI number for Stacey Clemenceau is 1265594113. It was assigned to this individual provider in the NPPES registry on December 15, 2006. The provider is also known as Dr. Stacey Nelson Ph.D..

Where is Stacey Clemenceau located?

Stacey Clemenceau practices at 820 Las Gallinas Ave, San Rafael, CA 94903. The listed phone number is (415) 444-3522.

What is Stacey Clemenceau's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Stacey Clemenceau enrolled in Medicare?

Yes. Stacey Clemenceau is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stacey Clemenceau's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stacey Clemenceau reassigns Medicare benefits to Permanente Medical Group Inc (Richmond, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stacey Clemenceau's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stacey Clemenceau was last updated on February 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.