Active NPI
Jenna Kerler
- Addiction (Substance Use Disorder) Counselor
- San Rafael, CA
National Provider Identifier
1568839926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- K1305171109
- Practice address
- 22 San Pablo Ave Apt 2
San Rafael, CA 94903-4122 - Phone
- (415) 747-9669
- NPI assigned
- Sep 1, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | K1305171109 | CA | Primary |
Addresses
Primary practice location
22 San Pablo Ave Apt 2
San Rafael, CA 94903-4122
Mailing address
22 San Pablo Ave Apt 2
San Rafael, CA 94903-4122
Phone (415) 747-9669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C4415624 | Medicaid | CA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| K1305171109 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441065600000",
"number": "1568839926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 SAN PABLO AVE APT 2",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034122",
"telephone_number": "415-747-9669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 SAN PABLO AVE APT 2",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034122",
"telephone_number": "415-747-9669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERLER",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-01",
"last_updated": "2015-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "K1305171109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "C4415624",
"state": "CA"
}
],
"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 Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.