NPIMap

Organization Active NPI

Sonoma Therapy Network

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Rosa, CA
National Provider Identifier
1356854673
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SONOMA THERAPY NETWORK
Practice address
3438 Mendocino Ave Ste B
Santa Rosa, CA 95403-2275
Phone
(707) 387-4525
Fax
(707) 843-5574
NPI assigned
Nov 8, 2017
Last updated
May 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Authorized official

Name
Garet David Waterhouse, LCSWNPI 1447425913
Title
Owner
Phone
(707) 387-4525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3438 Mendocino Ave Ste B
Santa Rosa, CA 95403-2275

Mailing address

3438 Mendocino Ave Ste B
Santa Rosa, CA 95403-2275
Phone (707) 387-4525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181009003637 CA Part B Supplier - Clinic/Group Practice 1759633357 Receives reassigned benefits from 5 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Locations

3000 Cleveland Ave
Ste 201
Santa Rosa, CA 95403
Phone (530) 327-8620

3438 Mendocino Ave
#B
Santa Rosa, CA 95403
Phone (707) 387-4525

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1356854673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3438 MENDOCINO AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032275",
            "telephone_number": "707-387-4525",
            "fax_number": "707-861-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3438 MENDOCINO AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032275",
            "telephone_number": "707-387-4525",
            "fax_number": "707-843-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONOMA THERAPY NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "WATERHOUSE",
        "authorized_official_first_name": "GARET",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-387-4525",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.