Active NPI
Shannon Renee Navarro, MFTI
- Marriage & Family Therapist
- Petaluma, CA
National Provider Identifier
1174872261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 78523
- Practice address
- 1500 Petaluma Blvd S
Petaluma, CA 94952-5545 - Phone
- (707) 559-2507
- NPI assigned
- Sep 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 78523 | CA | Primary |
Addresses
Primary practice location
1500 Petaluma Blvd S
Petaluma, CA 94952-5545
Mailing address
23 Locke LN
Mill Valley, CA 94941-2112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 18, 2024 through Jan 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439337600000",
"number": "1174872261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 LOCKE LN",
"city": "MILL VALLEY",
"state": "CA",
"postal_code": "949412112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 PETALUMA BLVD S",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949525545",
"telephone_number": "707-559-2507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAVARRO",
"first_name": "SHANNON",
"middle_name": "RENEE",
"credential": "MFTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-05",
"last_updated": "2015-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "78523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.