Active NPI
Kelly Pemberton, LMFT #100286
- Marriage & Family Therapist
- Sacramento, CA
National Provider Identifier
1225470503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 2701 I St
Sacramento, CA 95816-4309 - Phone
- (916) 668-0297
- NPI assigned
- Jul 26, 2013
- 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 | Primary |
Addresses
Primary practice location
2701 I St
Sacramento, CA 95816-4309
Mailing address
PO Box 19002
Sacramento, CA 95819-0002
Phone (916) 668-0297
Other practice location 1
6765 Green Valley Rd
Placerville, CA 95667-8984
Phone (530) 622-5551
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 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100286 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1225470503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19002",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958190002",
"telephone_number": "916-668-0297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 I ST",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958164309",
"telephone_number": "916-668-0297"
}
],
"practiceLocations": [
{
"address_1": "6765 Green Valley Rd",
"address_purpose": "LOCATION",
"city": "Placerville",
"state": "CA",
"postal_code": "956678984",
"country_code": "US",
"telephone_number": "530-622-5551",
"fax_number": "530-622-5800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEMBERTON",
"first_name": "KELLY",
"credential": "LMFT #100286",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-26",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.