Shannon Renee Vanderberg

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC90568 Issued in CA

Practice address

19231 Victory Blvd Ste 110
Reseda, CA 91335-6321

Phone

(818) 708-4500

Fax

(818) 654-1956

NPI assigned

Jun 22, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Shannon Renee Washington Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1306073952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD STE 110",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356321",
            "telephone_number": "818-708-4500",
            "fax_number": "818-654-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD STE 110",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356321",
            "telephone_number": "818-708-4500",
            "fax_number": "818-654-1956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7003 North Figueroa St.",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900416418",
            "country_code": "US",
            "telephone_number": "323-543-4233",
            "fax_number": "323-344-7382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERBERG",
        "first_name": "SHANNON",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC90568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "WASHINGTON",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Narine Vardanyan, FNP-C
• Anush Vardumyan

• Marriage & Family Therapist in Reseda, CA
• Providers in Reseda, 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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.