Active NPI
Marc Teitelbaum, MFT
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1669733747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC 36726
- Practice address
- 2340 Ward St
#204
Berkeley, CA 94705-1124 - Phone
- (510) 524-8497
- NPI assigned
- Jun 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | MFC 36726 | CA | Primary |
Addresses
Primary practice location
2340 Ward St
#204
Berkeley, CA 94705-1124
Mailing address
2340 Ward St
#204
Berkeley, CA 94705-1124
Phone (510) 524-8497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240223003451 | CA | Practitioner - Marriage and Family Therapist | 8628413168 | Practice locations: Kensington, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC 36726 | CA | MD | Marriage & Family Therapist |
| 36726 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338854400000",
"number": "1669733747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2340 WARD ST",
"address_2": "#204",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051124",
"telephone_number": "510-524-8497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2340 WARD ST",
"address_2": "#204",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051124",
"telephone_number": "510-524-8497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEITELBAUM",
"first_name": "MARC",
"name_prefix": "Mr.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-05",
"last_updated": "2012-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC 36726",
"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 Jun 5, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.