Dr Stacey Nelson Clemenceau, PHD in San Rafael, CA

Dr Stacey Nelson Clemenceau, PHD is a medicare enrolled "Psychologist - Clinical" provider in San Rafael, California. Her current practice location is 820 Las Gallinas Ave, San Rafael, California. You can reach out to her office (for appointments etc.) via phone at (415) 444-3522.

Dr Stacey Nelson Clemenceau is licensed to practice in California (license number PSY16162) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1265594113.

Contact Information

	Dr Stacey Nelson Clemenceau, PHD
	820 Las Gallinas Ave, San Rafael, CA 94903-3410
	(415) 444-3522
	(415) 444-3019

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Stacey Nelson Clemenceau
Gender	Female
Speciality	Psychologist - Clinical
Location	820 Las Gallinas Ave, San Rafael, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1265594113
Provider Enumeration Date: 12/15/2006
Last Update Date: 02/11/2022

Medicare PECOS Information:

PECOS PAC ID: 6709163793
Enrollment ID: I20170428001488

Medical Identifiers

Medical identifiers for Dr Stacey Nelson Clemenceau such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1265594113	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TC0700X	Psychologist - Clinical	PSY16162 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Stacey Nelson Clemenceau allows following entities to bill medicare on her behalf.

Entity Name	Permanente Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Stacey Nelson Clemenceau is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Stacey Nelson Clemenceau, PHD 820 Las Gallinas Ave, San Rafael, CA 94903-3410 Ph: (415) 444-3522	Dr Stacey Nelson Clemenceau, PHD 820 Las Gallinas Ave, San Rafael, CA 94903-3410 Ph: (415) 444-3522

Reviews and Comments

Psychologist in San Rafael, CA

Miss Geeta Ann Davidson, M.S. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 20 N San Pedro Rd, San Rafael, CA 94903 Phone: 415-473-7637
Dr. Leslie Frances Chatham, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 820 Las Gallinas Ave, San Rafael, CA 94903 Phone: 415-444-3522 Fax: 415-444-3019
Dr. Carol H Pollard, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 16 Jeanette Prandi Way, Marin Co Juvenile Hall, San Rafael, CA 94903 Phone: 415-499-6894
Dr. Ann Gold Buscho, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 711 D St, Suite 207, San Rafael, CA 94901 Phone: 415-456-0952
Dr. Boukje Elisabeth Eerkens, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1050 Northgate Dr Ste 12, San Rafael, CA 94903 Phone: 415-272-3406 Fax: 415-300-3086
Stephanie Lopez, Psychologist Medicare: Medicare Enrolled Practice Location: 111 Smith Ranch Rd, San Rafael, CA 94903 Phone: 415-491-3127
Dr. Ali Navarro, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 820 Las Gallinas Ave, San Rafael, CA 94903 Phone: 415-444-3522 Fax: 415-444-3019

Dr Stacey Nelson Clemenceau, PHD - Medicare Psychologist in San Rafael, CA