Active NPI
Nicole Koethner, MA, MFT
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1073946000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 46109
- Practice address
- 2113 Woolsey Street
Berkeley, CA 94705 - Phone
- (510) 779-2842
- NPI assigned
- Aug 13, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | 46109 | CA | Primary |
Addresses
Primary practice location
2113 Woolsey Street
Berkeley, CA 94705
Mailing address
130 Wood LN
Fairfax, CA 94930
Phone (510) 282-8161
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46109 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575504000000",
"number": "1073946000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 WOOD LN",
"city": "FAIRFAX",
"state": "CA",
"postal_code": "94930",
"telephone_number": "510-282-8161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2113 WOOLSEY STREET",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94705",
"telephone_number": "510-779-2842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOETHNER",
"first_name": "NICOLE",
"name_prefix": "Ms.",
"credential": "MA, MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-13",
"last_updated": "2019-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "46109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.