Active NPI
Astrid Koltun
- Marriage & Family Therapist
- San Rafael, CA
National Provider Identifier
1447782115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 123302
- Practice address
- 1330 Lincoln Avenue
Suite #201
San Rafael, CA 99401 - Phone
- (415) 459-5999
- NPI assigned
- Mar 31, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 9330947 | CA | |
| Marriage & Family Therapist | 106H00000X | 123302 | CA | Primary |
Addresses
Primary practice location
1330 Lincoln Avenue
Suite #201
San Rafael, CA 99401
Mailing address
12 Penny LN
Fairfax, CA 94930-1319
Phone (415) 686-8145
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123302 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Institute for Psychotherapy | Past | Accepting new patients | |
| Community Institute for Psychotherapy | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Voluntary or Charitable Agency
- San Rafael, CA
- NPI 1760403794
-
- Community/Behavioral Health Agency
- San Rafael, CA
- NPI 1780995258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1447782115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 PENNY LN",
"city": "FAIRFAX",
"state": "CA",
"postal_code": "949301319",
"telephone_number": "415-686-8145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 LINCOLN AVENUE",
"address_2": "SUITE #201",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "99401",
"telephone_number": "415-459-5999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLTUN",
"first_name": "ASTRID",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-31",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "9330947",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "123302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.