Kerstin Manderson Sidney, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCS29222 Issued in CA

Practice address

1021 Fremont Ave
South Lake Tahoe, CA 96150-8136

Phone

(530) 541-2445

Fax

(530) 541-0517

NPI assigned

May 3, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kerstin Nicole Manderson-Sidney Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484611200000",
    "number": "1023377561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13633",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961513633",
            "telephone_number": "949-302-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 FREMONT AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961508136",
            "telephone_number": "530-541-2445",
            "fax_number": "530-541-0517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDNEY",
        "first_name": "KERSTIN",
        "middle_name": "MANDERSON",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-03",
        "last_updated": "2017-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW23055",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCS29222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERSTIN",
            "last_name": "MANDERSON-SIDNEY",
            "middle_name": "NICOLE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Kelly Shanahan, MD
• Jamie Sheets
• William R Shepard, DO
• Heather Lynn Shook
• Brett Erica Sibley, PA-C
• Sierra Child & Family Services
• Sierra Family Care Inc
• Sierra Mental Wellness Group
• Sierra Nevada Medical Imaging Inc a Medical Corporation
• Sierra Recovery Center

• Mental Health Counselor in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.