Active NPI
Maureen D Perriello, MFTI
- Counselor
- San Pablo, CA
National Provider Identifier
1063531499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- IMF 49694
- Practice address
- 2853 Groom Dr
San Pablo, CA 94806-2664 - Phone
- (510) 812-4700
- Fax
- (510) 222-3986
- NPI assigned
- Mar 28, 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | IMF 49694 | CA | Primary |
Addresses
Primary practice location
2853 Groom Dr
San Pablo, CA 94806-2664
Mailing address
2292 Clearview Cir
Benicia, CA 94510-2064
Phone (707) 758-8025
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 |
|---|---|---|---|
| IMF 49694 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063531499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2292 CLEARVIEW CIR",
"city": "BENICIA",
"state": "CA",
"postal_code": "945102064",
"telephone_number": "707-758-8025",
"fax_number": "510-222-3986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2853 GROOM DR",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948062664",
"telephone_number": "510-812-4700",
"fax_number": "510-222-3986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRIELLO",
"first_name": "MAUREEN",
"middle_name": "D",
"name_prefix": "Ms.",
"credential": "MFTI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "IMF 49694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pablo, 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.