Todd Newell Henderson, CCAPP, CAADE, NAADAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

10417-R Issued in CA

Practice address

2560 Pulgas Ave
East Palo Alto, CA 94303-1323

Phone

(650) 325-6466

Fax

(650) 325-6467

NPI assigned

Mar 8, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Our Common Ground, Inc. - Epa

  • Substance Abuse Rehabilitation Facility
  • East Palo Alto, CA
  • NPI 1366844060
  NPD (past)

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

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1437651189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 WOODSIDE ROAD",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 PULGAS AVE",
            "city": "EAST PALO ALTO",
            "state": "CA",
            "postal_code": "943031323",
            "telephone_number": "650-325-6466",
            "fax_number": "650-325-6467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "TODD",
        "middle_name": "NEWELL",
        "name_prefix": "Mr.",
        "credential": "CCAPP, CAADE, NAADAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "125615",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "10417-R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "101YA0400X",
            "identifier": "101YA0400X",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YA0400X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalimar Guerra, C.A.T.C.
• Amanda Haiman Gersich, M.D.
• Renee Hazel Harris
• Healthright360
• Helping Others Maintain Earth, Inc
• Ethany Irene Hernandez
• Jessica Hernandez, RN
• Monica Hernandez, REGISTERED NURSE
• Zachery Hernandez, RADT I
• Leyla I Herrera, RN

• Addiction (Substance Use Disorder) Counselor in East Palo Alto, CA
• Providers in East Palo Alto, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.