Research and Student Research Psychoanalysts

All licensees/registrants are required to professionally use the name they are licensed/registered with the Medical Board of California (Board). Using any other name may confuse or mislead the public and may be considered, by the Board, unprofessional conduct.

Any licensee/registrant who wishes to change the professional name under which they practice must complete and submit a Notification of Name Change form to the Board along with required supporting legal documentation.

California law requires each licensee/registrant to report name changes to the Board within 30 days of the name change.

Note: You cannot practice under your middle name when your license is issued with your first, middle, and last name.

No fee is required to process a name change; however, there is a fee to request a duplicate wall certificate with the new name. A new wallet license may be generated by utilizing the Wallet License Generator; there is no fee for this service.

Note: If a licensee/registrant also holds a professional license/registration issued by any of the California Boards and Bureaus listed below, you only need to submit one Notification of Name Change Form to any of the Boards or Bureaus listed. One form will create a name change at each of the Boards and Bureaus listed in which you hold a license/registration.

• Board of Podiatric Medicine
• Board of Registered Nursing
• California Board of Barbering and Cosmetology
• California Board of Behavioral Science
• California Board of Psychology
• Naturopathic Medicine Committee
• Osteopathic Medical Board of California
• Physician Assistant Board
• Respiratory Care Board
• Dental Board of California
• Dental Hygiene Board of California
• Veterinary Medical Board
• Physical Therapy Board
• Board of Optometry
• Board of Vocational Nursing and Psychiatric Technicians
• Board of Occupational Therapy
• Bureau of Security and Investigative Services

If you hold a license/registration with any other California Board or Bureau not listed above, you will need to submit a separate name change form directly to that Board or Bureau.

A wall certificate reflecting the name change will NOT automatically be issued. If you desire a duplicate wall certificate with your new name, you must complete an Application for Duplicate Certificate and submit the appropriate fees. A new wallet license may be generated by utilizing the Wallet License Generator; there is no fee for this service.

At your next renewal, your renewal notice will automatically print with your new name.

Required Documentation:

A current government-issued photographic identification card (e.g., driver license, alien registration, passport, etc.) AND one of the following legal documents as proof of name change:

• Certified Court Order;
• Marriage Certificate, or
• Dissolution of Marriage (Divorce)

Original documents are not required, photocopies will be accepted. If original documents are mailed, they will be returned by certified mail.

California law requires all licensees/registrants to report each and every change of address/email within 30 days after each change. The request to change or update the address/email must be submitted in writing with the following information: name, license/registration number, old and new address, signature, and date.

You may submit a change of address/email by one of the following methods:

If the new address is a post office box, the licensee/registrant is required by law to provide the Board with a separate street address which will be kept confidential and not publicly disclosed. The street address of a private mailbox service may not be used as a confidential street address. Even if a licensee/registrant provides a street address as their address of record, they may provide a second street address that will remain confidential.

NOTE: California law requires the Board to provide, upon written or verbal request, the address of record of any licensee or registrant. The address of record will be released to any individual or entity who inquires and is also available to the public on the Board's website. Each licensee/registrant should carefully consider the address of record provided to the Board, and may wish to use an office, employer's address, or a post office box as the address of record.

The Board uses the address of record to mail all licenses, renewal notices, and all other official correspondence, therefore, the licensee/registrant is responsible for all communications sent to their address of record.

• Frequently Asked Questions - Change of Address / Address of Record / Email Address

When informing the Medical Board of the death of a research psychoanalyst registrant, you must provide a copy of the Certificate of Death or a notarized statement attesting to the registrant's death. When possible, please include the individual's registration number.