Active NPI
Phoenix Song, LMFT
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1003583220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 109093
- Practice address
- 1400 Shattuck Ave, Ste 12
#228
Berkeley, CA 94709-1411 - Phone
- (415) 545-8215
- NPI assigned
- Aug 25, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 109093 | CA | Primary |
Addresses
Primary practice location
1400 Shattuck Ave, Ste 12
#228
Berkeley, CA 94709-1411
Mailing address
1400 Shattuck Ave, Ste 12
#228
Berkeley, CA 94709-1411
Phone (415) 545-8215
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109093 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640563200000",
"number": "1003583220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 SHATTUCK AVE, STE 12",
"address_2": "#228",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091411",
"telephone_number": "415-545-8215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 SHATTUCK AVE, STE 12",
"address_2": "#228",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091411",
"telephone_number": "415-545-8215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "PHOENIX",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-25",
"last_updated": "2021-12-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "109093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.