1. Home
  2. Directory
  3. California
  4. San Rafael
  5. Psychologist
  6. NPI Profile

DR. MIRIAM FAGAN PSYD
NPI 1487283685
Psychologist - Clinical in San Rafael, CA

Active since April 08, 2020Opted out of Medicare · through Nov 8, 2027
111 SMITH RANCH RD, SAN RAFAEL, CA 94903(415) 491-3003 Get Directions Write a Review

NPPES record last updated: April 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 2, 2024, Jan 3, 2022, Apr 8, 2020 (3 updates tracked since 2020).

About Dr. Miriam Fagan Psyd NPPES

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

DR. MIRIAM FAGAN PSYD (NPI 1487283685) is an individual clinical provider in San Rafael, California, licensed in California (31718) and active in the NPI registry since April 2020. She has opted out of Medicare through November 8, 2027.

NPPES Registry Identity

NPI1487283685
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. MIRIAM FAGANCredential: PSYD
Location Address111 SMITH RANCH RDSan Rafael, CA 94903-1939
Mailing Address775 E Blithedale Ave # 141Mill Valley, CA 94941-1554 · (415) 569-5113
Phone(415) 491-3003
Sole ProprietorNo
Enumeration DateApril 8, 2020
Last NPPES UpdateApril 2, 20243 updates tracked since enumeration
NPPES CertifiedApril 2, 2024
✔ NPI 1487283685 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 · 31718
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.
111 SMITH RANCH RD, San Rafael, CA 94903
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Miriam Fagan Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 8, 2023 through November 8, 2027.

Opt-Out Effective DateNovember 8, 2023
Opt-Out In Effect ThroughNovember 8, 2027Opt-out affidavits renew automatically every two years unless cancelled

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.

STEPHANIE LOPEZ
Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3127
ASFAND KHAN
Psychiatry & Neurology (Psychiatry)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000
JENNIFER DAWN ROSSI MA
Marriage & Family Therapist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000
AMY NICOLE URBAN
Marriage & Family Therapist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000
DR. KIM HUONG HUYNH PH.D.
Psychologist (Clinical)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3011
CORINNE HEIMER
Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000
JONATHAN MICHAEL DUBOS
Psychologist (Clinical Child & Adolescent)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000
SHIRI LICHTENSTEIN PSYD
Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marin County (415) 491-3000

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 Miriam Fagan's NPI number?

The NPI number for Miriam Fagan is 1487283685. It was assigned to this individual provider in the NPPES registry on April 8, 2020.

Where is Miriam Fagan located?

Miriam Fagan practices at 111 Smith Ranch Rd, San Rafael, CA 94903. The listed phone number is (415) 491-3003.

What is Miriam Fagan's specialty?

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

Is Miriam Fagan enrolled in Medicare?

No. Miriam Fagan has opted out of Medicare through November 8, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Miriam Fagan was last updated on April 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.