Mardi A. Geredes, MA, RRW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RW0886 Issued in CA

Practice address

2945 McMillan Ave
Ste. 136
San Luis Obispo, CA 93401-6766

Phone

(805) 781-1433

Fax

(805) 781-1267

NPI assigned

May 15, 2007

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194931014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 MCMILLAN AVE",
            "address_2": "STE. 136",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016766",
            "telephone_number": "805-781-1433",
            "fax_number": "805-781-1267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 MCMILLAN AVE",
            "address_2": "STE. 136",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016766",
            "telephone_number": "805-781-1433",
            "fax_number": "805-781-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEREDES",
        "first_name": "MARDI",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "MA, RRW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RW0886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.