Kristin Bloomer Archdeacon, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCSW80860 Issued in CA

Practice address

725 E Santa Clara St Ste 105
San Jose, CA 95112-1936

Phone

(408) 961-4645

NPI assigned

Mar 15, 2023

Last updated

Mar 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Santa Clara

  dba Downtown Youth Wellness Center MH Tay

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Jose, CA
  • NPI 1659087567
  NPD

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1427759406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S 14TH ST # 2",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951122016",
            "telephone_number": "408-829-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 E SANTA CLARA ST STE 105",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951121936",
            "telephone_number": "408-961-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHDEACON",
        "first_name": "KRISTIN",
        "middle_name": "BLOOMER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCSW80860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Holly-Marie Arce, PSY.D.
• Tamara Denise Arceneaux, BCAT
• Stacy Anne Archer, BA, MA
• Robert William Reid Archibald, MBCHB
• Jalina Archuleta
• Julia Archuleta
• Marissa Archuleta

• Mental Health Counselor in San Jose, CA
• Providers in San Jose, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.