Irma Rivera-Carlisle, MDIV, M.A., MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MFC45828 Issued in CA

Practice address

1036 Sir Francis Drake Blvd
Kentfield, CA 94904-1427

Phone

(415) 246-5051

Fax

(415) 482-0863

NPI assigned

May 14, 2007

Last updated

Jan 29, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 4, 2024 through Jan 4, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327795200000",
    "number": "1639385222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1522",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949791522",
            "telephone_number": "415-246-5051",
            "fax_number": "415-482-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 SIR FRANCIS DRAKE BLVD",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041427",
            "telephone_number": "415-246-5051",
            "fax_number": "415-482-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA-CARLISLE",
        "first_name": "IRMA",
        "name_prefix": "Ms.",
        "credential": "MDIV, M.A., MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2012-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "MFC45828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Suhay Sylvia Rivas, BA
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• Christopher Roebken, D.D.S
• Curtis K. Roebken, MD
• Ross Valley Physical Therapy, Inc.
• Vannessa Lyn Rostchild

• Mental Health Counselor in Kentfield, CA
• Providers in Kentfield, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.