Katrina P Mautner

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2712 Telegraph Ave
Berkeley, CA 94705-1117

Phone

(510) 548-8283

NPI assigned

Sep 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 18, 2024 through Sep 18, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Center for Human Growth

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Berkeley, CA
  • NPI 1043434095
  NPD (past)
• Pacific Center for Human Growth

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1275687717
  NPD (past)

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1083196075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051117",
            "telephone_number": "510-548-8283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUTNER",
        "first_name": "KATRINA",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-05",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Fareri Matthews, L.AC.
• John T Mattson, MD
• Margot S. Maurer, L.C.S.W.
• Anna Maurice, LMFT
• Marlon Maus, M.D. DRPH
• Vanessa Marie Mayen, R.N., N.P.
• Lior Mayer, CNM
• Michael Howard Mayer, PH.D.
• Davier Davon Mayes, RVS
• John V Maynes, L.AC.

• Student in an Organized Health Care Education/Training Program in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.