Active NPI
Heidi Crystal Bonfigli, M.S., M.A. LMFT
- Marriage & Family Therapist
- Sonoma, CA
National Provider Identifier
1245698372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 117296
- Practice address
- 766 W Napa St
Sonoma, CA 95476-6452 - Phone
- (415) 246-4961
- NPI assigned
- Feb 3, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | 117296 | CA | Primary |
Addresses
Primary practice location
766 W Napa St
Sonoma, CA 95476-6452
Mailing address
766 W Napa St
Sonoma, CA 95476-6452
Phone (415) 246-4961
Other names 1
- Heidi Crystal Lage
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 20, 2024 through Mar 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117296 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Side by Side | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- San Anselmo, CA
- NPI 1912434929
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612569600000",
"number": "1245698372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "766 W NAPA ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "954766452",
"telephone_number": "415-246-4961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "766 W NAPA ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "954766452",
"telephone_number": "415-246-4961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONFIGLI",
"first_name": "HEIDI",
"middle_name": "CRYSTAL",
"name_prefix": "Mrs.",
"credential": "M.S., M.A. LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-03",
"last_updated": "2021-02-06",
"certification_date": "2021-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "117296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HEIDI",
"last_name": "LAGE",
"middle_name": "CRYSTAL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Sonoma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2021; 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.