Individual provider Active NPI

Danielle Marie Vidart, LMFT

  • Marriage & Family Therapist
  • Riverside, CA
National Provider Identifier
1528516341
Registry record updated Apr 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
19330 Jesse LN Ste 280
Riverside, CA 92508-5091
Phone
(951) 387-4040
NPI assigned
Sep 21, 2016
Last updated
Apr 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 95249 CA
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

19330 Jesse LN Ste 280
Riverside, CA 92508-5091

Mailing address

PO Box 1695
Lemon Grove, CA 91946-1695

Other practice location 1

233 W. Baseline Rd
La Verne, CA 91750
Phone (909) 593-2581

Other names 1

  • Danielle Marie Bowen Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240122002133 CA Practitioner - Marriage and Family Therapist 3375995749 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95249CAMDMental Health Counselor
111893CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Soultenders, Inc. Mental Health CurrentSince Jan 1, 2024 Accepting new patients
Family Talk Therapy Center Marriage & Family Therapist PastSince Sep 8, 2019 Accepting new patients

Locations

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006
Phone (626) 701-4249

10532 Acacia St
Ste B4
Rch Cucamonga, CA 91730
Phone (909) 325-3766

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.

NPI Registry JSON

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1528516341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1695",
            "city": "LEMON GROVE",
            "state": "CA",
            "postal_code": "919461695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19330 JESSE LN STE 280",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085091",
            "telephone_number": "951-387-4040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "233 W. Baseline Rd",
            "address_purpose": "LOCATION",
            "city": "La Verne",
            "state": "CA",
            "postal_code": "91750",
            "country_code": "US",
            "telephone_number": "909-593-2581",
            "fax_number": "909-833-2998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDART",
        "first_name": "DANIELLE",
        "middle_name": "MARIE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "95249",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "BOWEN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.