NPIMap

Organization Active NPI

Psychosocial Therapy Licensed Marriage and Family Therapists Inc.

Doing business as PsychoSocial Therapy

  • Marriage & Family Therapist
  • Berkeley, CA
National Provider Identifier
1134872971
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
PSYCHOSOCIAL THERAPY LICENSED MARRIAGE AND FAMILY THERAPISTS INC.
Doing business as
PsychoSocial Therapy
Practice address
1918 Bonita Ave Ste 200
Berkeley, CA 94704-1014
Phone
(510) 288-6336
NPI assigned
Feb 1, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Luis Alfredo Cornejo, LMFTNPI 1659732188
Title
President
Phone
(510) 288-6336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

1918 Bonita Ave Ste 200
Berkeley, CA 94704-1014

Mailing address

1918 Bonita Ave Ste 200
Berkeley, CA 94704-1014
Phone (510) 288-6336

Other practice location 1

430 Golden Gate Ave Apt 104
Richmond, CA 94801-3885
Phone (510) 288-6336

Other names 1

  • PsychoSocial Therapy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1134872971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 BONITA AVE STE 200",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041014",
            "telephone_number": "510-288-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 BONITA AVE STE 200",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041014",
            "telephone_number": "510-288-6336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 Golden Gate Ave Apt 104",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "CA",
            "postal_code": "948013885",
            "country_code": "US",
            "telephone_number": "510-288-6336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHOSOCIAL THERAPY LICENSED MARRIAGE AND FAMILY THERAPISTS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "ALFREDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-288-6336",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PsychoSocial Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 1, 2022; 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.