Active NPI
Latisha Funmilola Ibironke
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1619003258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 46518
- Practice address
- 1820 Scenic Ave
Berkeley, CA 94709-1324 - Phone
- (510) 548-7270
- Fax
- (510) 841-4722
- NPI assigned
- Feb 26, 2007
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 46518 | CA | Primary |
Addresses
Primary practice location
1820 Scenic Ave
Berkeley, CA 94709-1324
Mailing address
2323 Hearst Ave
Berkeley, CA 94709-1319
Phone (510) 526-6200
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 |
|---|---|---|---|
| 46518 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Bridge Foundation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Berkeley, CA
- NPI 1447436688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516838400000",
"number": "1619003258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2323 HEARST AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091319",
"telephone_number": "510-526-6200",
"fax_number": "510-665-3176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 SCENIC AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091324",
"telephone_number": "510-548-7270",
"fax_number": "510-841-4722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBIRONKE",
"first_name": "LATISHA",
"middle_name": "FUNMILOLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-26",
"last_updated": "2018-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "46518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.