Marc D. Komori Stager, PSYD Family Psychology a Professional Corporati

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MARC D. KOMORI STAGER, PSYD FAMILY PSYCHOLOGY A PROFESSIONAL CORPORATI

Practice address

3375 Port Chicago Hwy Ste 15
Unit #520
Concord, CA 94520

Phone

(925) 325-5022

NPI assigned

Jun 29, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Marc D. Komori Stager, PSYDNPI 1962578559

Title

President

Phone

(925) 325-5022

Specialties & licenses 1

Addresses

Other names 1

• East Bay Family Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc D. Komori Stager, PSY.D.

  • Psychologist
  • Walnut Creek, CA
  • NPI 1962578559
  NPD Authorized official

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1043997273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2203",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "945105203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 PORT CHICAGO HWY STE 15",
            "address_2": "UNIT #520",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "94520",
            "telephone_number": "925-325-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARC D. KOMORI STAGER, PSYD FAMILY PSYCHOLOGY A PROFESSIONAL CORPORATI",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "KOMORI STAGER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-325-5022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay Family Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angie Mar
• Gladys Mar
• Isabel Maria Maravilla
• Shayla Abigail Maravilla
• Dayana Maravillo Sanchez
• Stella May Marceleno
• Brenna Ann Marcella
• Chelsea P. Marcelle, DPT
• Jacqueline M Marcelo Brito
• Dianne Marcelo

• Mental Health Clinic/Center (Including Community Mental Health Center) in Concord, CA
• Providers in Concord, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.