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

Q: 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.

Q: What is Laura Fannon's specialty?

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

Q: 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.

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: August 09, 2026.

On this page

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

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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, and ordering and referring status from the CMS PECOS system.

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.

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