Maggie Rose Self, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

53133 Issued in CA

Practice address

7765 Healdsburg Ave
Sebastopol, CA 95472

Phone

(707) 583-9518

NPI assigned

Jul 1, 2008

Last updated

May 30, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maggie Self, LMFT

  • Marriage & Family Therapist
  • Sebastopol, CA
  • NPI 1306484605
  NPD (past) Authorized official

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1215199054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954730173",
            "telephone_number": "707-583-9518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7765 HEALDSBURG AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "95472",
            "telephone_number": "707-583-9518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "919 McFarlane Ave",
            "address_purpose": "LOCATION",
            "city": "Sebastopol",
            "state": "CA",
            "postal_code": "954724419",
            "country_code": "US",
            "telephone_number": "707-583-9518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SELF",
        "first_name": "MAGGIE",
        "middle_name": "ROSE",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "53133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sebastopol Physical Therapy and Pilates Studio
• Sebastopol Union School District
• Sebastopol Urgent Care
• Seeking Peace Therapy, a Licensed Clinical Social Worker (Caitlin Steele, LCSW)
• Lawrence Segrue
• Silvano Constantino Senn, D.D.S.
• Serenity Villa Inc
• Wowlvenn Seward-Katzmiller, MFT
• David Wayne Sexton, MSW
• Ally Shamseldin

• Marriage & Family Therapist in Sebastopol, CA
• Providers in Sebastopol, 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 May 30, 2018; 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.