Active NPI
Jennifer Fernanda Vallecillo
- Mental Health Counselor
- San Fernando, CA
National Provider Identifier
1003370586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 566 S Brand Blvd
San Fernando, CA 91340-4002 - Phone
- (818) 898-0223
- NPI assigned
- Jan 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
566 S Brand Blvd
San Fernando, CA 91340-4002
Mailing address
24425 Woolsey Canyon Rd SPC 106
Canoga Park, CA 91304-6928
Phone (818) 331-3816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro de Amistad, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- San Fernando, CA
- NPI 1184740623
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1003370586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24425 WOOLSEY CANYON RD SPC 106",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913046928",
"telephone_number": "818-331-3816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "566 S BRAND BLVD",
"city": "SAN FERNANDO",
"state": "CA",
"postal_code": "913404002",
"telephone_number": "818-898-0223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLECILLO",
"first_name": "JENNIFER",
"middle_name": "FERNANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-29",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Fernando, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.