Active NPI
Edon Berkenstadt
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1376919118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT86974
- Practice address
- 5100 Marlborough Dr
San Diego, CA 92116-2020 - Phone
- (619) 980-1420
- NPI assigned
- Aug 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT86974 | CA | Primary |
Addresses
Primary practice location
5100 Marlborough Dr
San Diego, CA 92116-2020
Mailing address
5100 Marlborough Dr
San Diego, CA 92116-2020
Phone (619) 980-1420
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250509001234 | CA | Practitioner - Marriage and Family Therapist | 2860919131 | Practice locations: San Diego, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT86974 | CA | MD | Marriage & Family Therapist |
| 86974 | CA | MD | Medical license number |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1376919118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 MARLBOROUGH DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162020",
"telephone_number": "619-980-1420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 MARLBOROUGH DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162020",
"telephone_number": "619-980-1420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERKENSTADT",
"first_name": "EDON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-17",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT86974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; 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.