NPIMap

Organization Active NPI

Redwood Psychology Center, Inc.

  • Group Psychotherapy Psychologist
  • Santa Rosa, CA
National Provider Identifier
1154768307
Registry record updated May 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
110000330 Issued in CA
Legal business name
REDWOOD PSYCHOLOGY CENTER, INC.
Practice address
709 Davis St
Santa Rosa, CA 95401-4767
Phone
(707) 525-9223
NPI assigned
May 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2013

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

Authorized official

Name
Mr. Antonio Madrid, PHDNPI 1881818292
Title
Executive Director
Phone
(707) 865-1200

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
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X 110000330 CA Primary

Addresses

Primary practice location

709 Davis St
Santa Rosa, CA 95401-4767

Mailing address

PO Box 519
Monte Rio, CA 95462-0519
Phone (707) 865-1200

Other names 1

  • Russian River Counselors Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Redwood Psychology Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

709 Davis St
Santa Rosa, CA 95401
Phone (707) 525-9223

Practitioners & affiliated clinicians

Practitioners 2

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": "1369785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1154768307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 519",
            "city": "MONTE RIO",
            "state": "CA",
            "postal_code": "954620519",
            "telephone_number": "707-865-1200",
            "fax_number": "707-865-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 DAVIS ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014767",
            "telephone_number": "707-525-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD PSYCHOLOGY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-29",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "MADRID",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-865-1200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "110000330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russian River Counselors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; 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.