Active NPI
Bianca Michelle Wilson
- Marriage & Family Therapist
- San Rafael, CA
National Provider Identifier
1043405525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 59219
- Practice address
- 10 N San Pedro Rd Ste 1020
San Rafael, CA 94903-4155 - Phone
- (415) 473-4306
- Fax
- (415) 473-4307
- NPI assigned
- Sep 7, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 59219 | CA | Primary |
Addresses
Primary practice location
10 N San Pedro Rd Ste 1020
San Rafael, CA 94903-4155
Mailing address
3217 Cohasset Rd
Chico, CA 95973-5404
Phone (530) 879-2456
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-1063 | Other | CA | FQHC MEDICARE PART A |
| ZZZ29799Z | Other | CA | FQHC MEDICARE PART B |
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 |
|---|---|---|---|
| 59219 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Marin | Past | Accepting new patients | |
| County of Marin | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Hope Older Adult Services
- Mental Health Clinic/Center (Including Community Mental Health Center)
- San Rafael, CA
- NPI 1326258856
-
- Community/Behavioral Health Agency
- San Rafael, CA
- NPI 1912116252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522368000000",
"number": "1043405525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3217 COHASSET RD",
"city": "CHICO",
"state": "CA",
"postal_code": "959735404",
"telephone_number": "530-879-2456",
"fax_number": "530-879-3932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 N SAN PEDRO RD STE 1020",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034155",
"telephone_number": "415-473-4306",
"fax_number": "415-473-4307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BIANCA",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-07",
"last_updated": "2018-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "59219",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART A",
"identifier": "05-1063",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART B",
"identifier": "ZZZ29799Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.