NPIMap

Organization Active NPI

Mary Magdalene Community Services Agency

  • Mental Health Counselor
  • Stockton, CA
National Provider Identifier
1093418048
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MARY MAGDALENE COMMUNITY SERVICES AGENCY
Doing business as
Mary Magdalene Community Services Agency
Practice address
620 N Aurora St Ste 7
Stockton, CA 95202-2276
Phone
(209) 888-4519
NPI assigned
Mar 27, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Mrs. Geneva Haynes
Title
Executive Director
Phone
(209) 888-4519

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Case Management Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC0400X

Addresses

Primary practice location

620 N Aurora St Ste 7
Stockton, CA 95202-2276

Mailing address

620 N Aurora St Ste 7
Stockton, CA 95202-2276
Phone (209) 888-4519

Other names 2

  • Mary Magdalene Community Services Agency Doing business as
  • Mary Magdalene Community Services Other name

National Provider Directory

National Provider Directory

Locations

620 N Aurora St
Ste 7
Stockton, CA 95202
Phone (209) 468-2385

620 N Aurora St
Ste 71149N
Stockton, CA 95202

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1093418048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N AURORA ST STE 7",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952022276",
            "telephone_number": "209-888-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N AURORA ST STE 7",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952022276",
            "telephone_number": "209-888-4519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY MAGDALENE COMMUNITY SERVICES AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "GENEVA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-888-4519",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Magdalene Community Services Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary Magdalene Community Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mary Magdalene Community Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.