Individual provider Active NPI

Athena M. Burnside

  • Adult Mental Health Clinic/Center
  • San Mateo, CA
National Provider Identifier
1023581196
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Practice address
1700 S Amphlett Blvd Ste 120
San Mateo, CA 94402-2711
Phone
(656) 683-2195
NPI assigned
Jan 10, 2019
Last updated
Apr 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary

Addresses

Primary practice location

1700 S Amphlett Blvd Ste 120
San Mateo, CA 94402-2711

Mailing address

1700 S Amphlett Blvd Ste 120
San Mateo, CA 94402-2711
Phone (656) 683-2195

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

NPI Registry JSON

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1023581196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S AMPHLETT BLVD STE 120",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022711",
            "telephone_number": "656-683-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S AMPHLETT BLVD STE 120",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022711",
            "telephone_number": "656-683-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "ATHENA",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-10",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2026; 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.