Amy Nicole Urban

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

111 Smith Ranch Rd
San Rafael, CA 94903

Phone

(415) 491-3000

NPI assigned

Jul 26, 2011

Sex

Female

Sole proprietor

Yes

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 Apr 19, 2024 through Apr 19, 2028

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 and National Provider Directory roles.

• Family Service Agency of Sonoma County

  • Community/Behavioral Health Agency
  • Santa Rosa, CA
  • NPI 1205982147
  NPD (past)

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1144508094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SMITH RANCH RD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SMITH RANCH RD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-491-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 Lombardi Ct",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954076798",
            "country_code": "US",
            "telephone_number": "707-545-4551 x256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "URBAN",
        "first_name": "AMY",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Lynn Ullom, MD
• Susan Mary Ann Ultsch, M.S.,CCC-SLP
• Madeline Underwood, MD
• Haluk E Uner, RPH,MS
• Lynda Beth Unkeless
• Meghan C Urban
• Shawn Uribe
• Julie Anna Urrutia Hingsbergen, MS, LMFT
• Courtney Uselton
• Yevgeniya Valchuk, D.D.S.

• Marriage & Family Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.