SUSAN LAKE PSYD
NPI 1962784488
Rehabilitation Counselor in San Rafael, CA

Q: What is Susan Lake's NPI number?

The NPI number for Susan Lake is 1962784488. It was assigned to this individual provider in the NPPES registry on September 10, 2011.

Q: What is Susan Lake's specialty?

The primary specialty registered for this NPI is Rehabilitation Counselor with taxonomy code 225C00000X.

Q: When was this NPI record last updated?

The NPPES record for Susan Lake was last updated on December 17, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 10, 2011PECOS EnrolledAccepts Medicare Assignment

1330 LINCOLN AVE STE 201, SAN RAFAEL, CA 94901(415) 459-5999 Get Directions Write a Review

NPPES record last updated: December 17, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Susan Lake Psyd NPPES

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

SUSAN LAKE PSYD (NPI 1962784488) is an individual rehabilitation counselor in San Rafael, California and active in the NPI registry since September 2011. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1962784488

Entity TypeIndividualFemale

Primary Taxonomy225C00000X

Provider Legal NameSUSAN LAKECredential: PSYD

Location Address1330 LINCOLN AVE STE 201San Rafael, CA 94901-2142

Mailing Address1330 Lincoln Ave Ste 201San Rafael, CA 94901-2142 · (415) 459-5999

Phone(415) 459-5999

Sole ProprietorNo

Medical School CMSOtherGraduated 2017

Enumeration DateSeptember 10, 2011

Last NPPES UpdateDecember 17, 2020

NPPES CertifiedNovember 16, 2020

✔ NPI 1962784488 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRehabilitation CounselorRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code225C00000X

Definition

An individual trained and educated in a systematic process of assisting persons with physical, mental, developmental, cognitive, and emotional disabilities to achieve their personal, career, and independent living goals assessment and appraisal, diagnosis and treatment planning, career (vocational) counseling, individual and group counseling interventions for adjustments to the medical and psychosocial impact of disability, case management, program evaluation and research, job analysis and placement counseling, and consultation on rehabilitation resources and technology. Certification generally requires a Master's degree with specialized courses in rehabilitation processes and technology.

Also ListedPsychologistTaxonomy 103T00000X

1330 LINCOLN AVE STE 201, San Rafael, CA 94901

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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

Susan Lake Psyd 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 ID5496115271

PECOS Enrollment IDI20230712003716

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.

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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.

JESSICA SANANES

Student in an Organized Health Care Education/Training Program