Individual provider Active NPI

Samantha Friedman

  • Marriage & Family Therapist
  • San Rafael, CA
National Provider Identifier
1578046967
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
127272 Issued in CA
Practice address
54 Dolores St
San Rafael, CA 94901-5105
Phone
(201) 602-0942
NPI assigned
Sep 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X 107284 CA
Marriage & Family Therapist 106H00000X 107284 CA
Marriage & Family Therapist 106H00000X 127272 CA Primary

Addresses

Primary practice location

54 Dolores St
San Rafael, CA 94901-5105

Mailing address

54 Dolores St
San Rafael, CA 94901-5105
Phone (201) 602-0942

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

LicenseStateTypeSpecialty
127272CAMDMarriage & Family Therapist
107284CAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1578046967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 DOLORES ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949015105",
            "telephone_number": "201-602-0942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 DOLORES ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949015105",
            "telephone_number": "201-602-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDMAN",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "107284",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "107284",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "127272",
            "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 18, 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.

Verify at the official NPI Registry.