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LAURA E FANNON PSYD INTERN
NPI 1720104615
Counselor - Mental Health in San Francisco, CA

Active since March 22, 2007PECOS EnrolledAccepts Medicare Assignment
760 HARRISON ST, SAN FRANCISCO, CA 94107(415) 836-1700(415) 836-1737 Get Directions Write a Review

NPPES record last updated: November 15, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Laura E Fannon Psyd Intern NPPES

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

LAURA E FANNON PSYD INTERN (NPI 1720104615) is an individual mental health provider in San Francisco, California and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS, maintains a secondary practice location in Petaluma, and is a graduate of Other (2007).

NPPES Registry Identity

NPI1720104615
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameLAURA E FANNONCredential: PSYD INTERN
Location Address760 HARRISON STSan Francisco, CA 94107-1235
Mailing Address1179 N Mcdowell BlvdPetaluma, CA 94954-6559 · (707) 559-7500 · Fax (707) 559-7620
Phone(415) 836-1700
Fax(415) 836-1737
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateMarch 22, 2007
Last NPPES UpdateNovember 15, 2019
✔ NPI 1720104615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
760 HARRISON ST, San Francisco, CA 94107
Open in Google Maps ↗

Secondary Practice Location 1

Location 11179 N McDowell BlvdPetaluma, CA 94954-6559 · Phone (707) 559-7500 · Fax (707) 559-7620

Other Identifiers 2

Other9942Sfgh Internal Use Only
Other9942Cbhs Internal Use Only-commercial Number

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Laura E Fannon Psyd Intern is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7214215706
PECOS Enrollment IDI20161103002574
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 Laura Fannon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Petaluma Health Center Inc
33 mi
Federally Qualified Health Center (FQHC)
1179 N MCDOWELL BLVD
Petaluma, CA 94954
  • Reassigned Medicare billing, California enrollment
  • 63 clinicians in this Medicare group
NPI 1588656268 (707) 559-7500

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

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.

HOLLY A DAVIDSON
Student in an Organized Health Care Education/Training Program
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
BRIAN GAC
Student in an Organized Health Care Education/Training Program
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
ALEXIS G STINGLEY RN
Registered Nurse (Psychiatric/Mental Health, Adult)
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
DULCE MARISOL DIAZ
Technician, Pathology (Phlebotomy)
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (628) 754-8738
MARILYN K ROBBINS
Specialist
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
MR. FRANCISCO VILLEGAS JR.
Student in an Organized Health Care Education/Training Program
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
MR. LEON KERMIT GARRETT JR.
Community Health Worker
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1700
MRS. ALICIA AVELLA
Behavior Analyst
760 HARRISON ST
SAN FRANCISCO, CA 94107
San Francisco County (415) 836-1729

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 Laura Fannon's NPI number?

The NPI number for Laura Fannon is 1720104615. It was assigned to this individual provider in the NPPES registry on March 22, 2007.

Where is Laura Fannon located?

Laura Fannon practices at 760 Harrison St, San Francisco, CA 94107. The listed phone number is (415) 836-1700.

What is Laura Fannon's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Laura Fannon enrolled in Medicare?

Yes. Laura Fannon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Laura Fannon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Laura Fannon reassigns Medicare benefits to Petaluma Health Center Inc (Petaluma, 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 Laura Fannon'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 Laura Fannon was last updated on November 15, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.