Individual provider Active NPI

Jocelynn N Verketis

  • Addiction (Substance Use Disorder) Counselor
  • Vallejo, CA
National Provider Identifier
1396452090
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
R1484190922 Issued in CA
Practice address
419 Pennsylvania St
Vallejo, CA 94590-6933
Phone
(707) 643-2715
NPI assigned
Nov 1, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X R1484190922 CA Primary

Addresses

Primary practice location

419 Pennsylvania St
Vallejo, CA 94590-6933

Mailing address

419 Pennsylvania St
Vallejo, CA 94590-6933
Phone (707) 643-2715

Other practice location 1

126 Ohio St
Vallejo, CA 94590-5049
Phone (707) 644-5501

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

State licenses

LicenseStateTypeSpecialty
R1484190922CAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1396452090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 PENNSYLVANIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906933",
            "telephone_number": "707-643-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 PENNSYLVANIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906933",
            "telephone_number": "707-643-2715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "126 Ohio St",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945905049",
            "country_code": "US",
            "telephone_number": "707-644-5501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERKETIS",
        "first_name": "JOCELYNN",
        "middle_name": "N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-01",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1484190922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.