Dylan Kersh-Oliva, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

107259 Issued in CA

Practice address

1363 Lincoln Ave Ste 4
San Rafael, CA 94901-2124

Phone

(415) 307-0947

NPI assigned

Mar 24, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1679100259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 WOODSIDE WAY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949011439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1363 LINCOLN AVE STE 4",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012124",
            "telephone_number": "415-307-0947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSH-OLIVA",
        "first_name": "DYLAN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "107259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Dylankersh@gmail.com",
            "affiliation": "N",
            "address_1": "1363 Lincoln Ave Ste 4",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949012124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristina Nadine Kenny, DPT
• Kent G Carlomagno a Prof Chiropractic Corp
• Jamie Kerby, MS
• Karin Kerk, M.D
• Jenna Kerler
• Barbara Jane Kessell
• Thomas Walter Kessler, MFT TRAINEE
• David J Kest, M.F.T.
• Caroline Jeanne Keystone
• Muftia Jamal Khalil

• Marriage & Family Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.