NPIMap

Organization Active NPI

Family Service Agency of the Central Coast

  • Mental Health Counselor
  • Santa Cruz, CA
National Provider Identifier
1104994136
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
FAMILY SERVICE AGENCY OF THE CENTRAL COAST
Practice address
104 Walnut Ave
Suite 208
Santa Cruz, CA 95060-3900
Phone
(831) 423-9444
Fax
(831) 423-9444
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Authorized official

Name
Mr. David Arthur Bianchi, M.S.P.H.
Title
Executive Director
Phone
(831) 423-9444

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X CA
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X CA

Addresses

Primary practice location

104 Walnut Ave
Suite 208
Santa Cruz, CA 95060-3900

Mailing address

104 Walnut Ave
Suite 208
Santa Cruz, CA 95060-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123001089 CA Part B Supplier - Clinic/Group Practice 1052213527 Receives reassigned benefits from 17 practitioners
Practice locations: Soquel, CA; Santa Cruz, CA

National Provider Directory

National Provider Directory
Tax ID family
Family Service CTRL Coast9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

104 Walnut Ave
Ste 212
Santa Cruz, CA 95060
Phone (408) 423-9444

114 E 5th St
Watsonville, CA 95076
Phone (408) 728-9009

Practitioners & affiliated clinicians

Practitioners 47

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

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525824000000",
    "number": "1104994136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WALNUT AVE",
            "address_2": "SUITE 208",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WALNUT AVE",
            "address_2": "SUITE 208",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603900",
            "telephone_number": "831-423-9444",
            "fax_number": "831-423-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICE AGENCY OF THE CENTRAL COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2018-05-09",
        "status": "A",
        "authorized_official_last_name": "BIANCHI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "831-423-9444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S.P.H."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.