Mackenzie Sodestrom, MA

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

287 17TH St Ste 205
Oakland, CA 94612

Phone

(510) 210-1191

NPI assigned

Jul 17, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Mackenzie Sodestrom Marriage & Family Therapy, Inc.

  • Marriage & Family Therapist
  • Oakland, CA
  • NPI 1275234494
  NPD Authorized official
• Community Presbyterian Counseling Center

  • Community/Behavioral Health Agency
  • San Ramon, CA
  • NPI 1710049044
  NPD (past)

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1356864854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 17TH ST STE 205",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946124116",
            "telephone_number": "510-210-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "287 17TH ST STE 205",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94612",
            "telephone_number": "510-210-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODESTROM",
        "first_name": "MACKENZIE",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-17",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yuliya Soboleva, RN
• Maximiliano Sobrero, MD
• Social Q
• Eileen M Soden, L.C.S.W.
• Shawna Sodersten
• Chan Mary Soeur
• Emma Rose Sofen, MA
• Soft Heart Psychology
• Jennifer Soh, DDS
• Dong Sun Sohn, M.D.

• Marriage & Family Therapist in Oakland, CA
• Providers in Oakland, 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 Aug 26, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.