Serena Kamdar Mazzola Professional Psychology Corporation

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SERENA KAMDAR MAZZOLA PROFESSIONAL PSYCHOLOGY CORPORATION

Doing business as

Blackhawk Family Development Center
Family Development Collective
Newport Beach Family Development Center

Practice address

4155 Blackhawk Plaza Cir Ste 101
Danville, CA 94506-4829

Phone

(925) 683-4884

NPI assigned

Dec 20, 2023

Organization subpart

No

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

Authorized official

Name

Serena MazzolaNPI 1871723965

Title

President

Phone

(925) 549-2610

Specialties & licenses 4

Addresses

Other names 4

• Blackhawk Family Development Center Doing business as
• Family Development Collective Doing business as
• Newport Beach Family Development Center Doing business as
• Surina Kamdar Mazzola Professional Psychology Corporation Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Serena Kamdar Mazzola, PSYD

  • Marriage & Family Therapist
  • San Ramon, CA
  • NPI 1871723965

  Psychologist

  NPD Authorized official

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

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1174392054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4155 BLACKHAWK PLAZA CIR STE 101",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064829",
            "telephone_number": "925-683-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 BLACKHAWK PLAZA CIR STE 101",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064829",
            "telephone_number": "925-683-4884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23 Corporate Plaza Dr Ste 150",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926607908",
            "country_code": "US",
            "telephone_number": "949-779-0414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SERENA KAMDAR MAZZOLA PROFESSIONAL PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-20",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "MAZZOLA",
        "authorized_official_first_name": "SERENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-549-2610"
    },
    "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackhawk Family Development Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Development Collective",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newport Beach Family Development Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surina Kamdar Mazzola Professional Psychology Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Diva S Seddick, M.D., C.M.
• Selin Khayatan OD Inc
• Tonya Semas, MFT
• Mark H Sembrat, D.C.
• Courtney F Sepic, N.P.
• Janelle Serrano
• Clifford John Sewell, M.D.
• Jamie Vanessa Shackelford, RD
• Sarika Shah, RD
• Sheetal Ashish Shah, D.O.

• Mental Health Counselor in Danville, CA
• Providers in Danville, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.