Active NPI
Corrissa Madden-Grubb
- Mental Health Counselor
- San Rafael, CA
National Provider Identifier
1255614889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 900 Fifth Avenue, Suite 150;
San Rafael, CA 94901 - Phone
- (405) 202-3859
- NPI assigned
- Sep 20, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
900 Fifth Avenue, Suite 150;
San Rafael, CA 94901
Mailing address
900 Reichert Ave #507
Novato, CA 94945
Phone (480) 202-3859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
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": "1316476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1255614889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 REICHERT AVE #507",
"city": "NOVATO",
"state": "CA",
"postal_code": "94945",
"telephone_number": "480-202-3859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 FIFTH AVENUE, SUITE 150;",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94901",
"telephone_number": "405-202-3859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDEN-GRUBB",
"first_name": "CORRISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-20",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.