Charles W Boomer

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

201 Alameda del Prado
Novato, CA 94949-6688

Phone

(415) 457-6964

Fax

(415) 491-0915

NPI assigned

Mar 26, 2010

Last updated

Aug 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Buckelew Programs

  • Community/Behavioral Health Agency
  • Santa Rosa, CA
  • NPI 1497587240
  NPD (past)
• Second Chance Hayward Recovery Center

  • Community/Behavioral Health Agency
  • Hayward, CA
  • NPI 1356543011
  NPD (past)

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1659695153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 ALAMEDA DEL PRADO STE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496698",
            "telephone_number": "415-457-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ALAMEDA DEL PRADO",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496688",
            "telephone_number": "415-457-6964",
            "fax_number": "415-491-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMER",
        "first_name": "CHARLES",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-26",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joleen D Bishop, N.P.
• Blessed at Home Care Agency LLC
• Richard Bodony, MD
• Raymond M Bonneau, MD
• Michelle Bonsignore, LMFT
• Ole Christian Borgesen, PT
• Jenny Eva Boris
• Borsting Laboratories, Inc
• Chris Bossone
• Daniel Jacob Boudagian

• Mental Health Counselor in Novato, CA
• Providers in Novato, 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 Aug 28, 2023; 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.