Healthcare Provider Details

I. General information

NPI: 1205921962
Provider Name (Legal Business Name): KELLY M RANSOM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST STE 600
SAN FRANCISCO CA
94104-3448
US

IV. Provider business mailing address

220 MONTGOMERY ST STE 600
SAN FRANCISCO CA
94104-3448
US

V. Phone/Fax

Practice location:
  • Phone: 510-575-3020
  • Fax:
Mailing address:
  • Phone: 510-575-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: