Active NPI
Marilyn Patricia Cornell, M.S, MFT
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1013080571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC28342
- Practice address
- 3821 Front St
San Diego, CA 92103-3019 - Phone
- (619) 293-0634
- Fax
- (619) 294-3225
- NPI assigned
- Nov 15, 2006
- 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 | MFC28342 | CA | Primary |
Addresses
Primary practice location
3821 Front St
San Diego, CA 92103-3019
Mailing address
3821 Front St
San Diego, CA 92103-3019
Phone (619) 293-0634
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MFT283420 | Other | CA | BLUE SHIELD OF CALIFORNIA |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC28342 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013080571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3821 FRONT ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033019",
"telephone_number": "619-293-0634",
"fax_number": "619-294-3225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3821 FRONT ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033019",
"telephone_number": "619-293-0634",
"fax_number": "619-294-3225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELL",
"first_name": "MARILYN",
"middle_name": "PATRICIA",
"name_prefix": "Ms.",
"credential": "M.S, MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC28342",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIFORNIA",
"identifier": "MFT283420",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.