Active NPI
Amanda Marie Mastrup, MA, LMFT 93544
- Marriage & Family Therapist
- Santa Rosa, CA
National Provider Identifier
1699026765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 93544
- Practice address
- 1360 N Dutton Ave
Ste. 100
Santa Rosa, CA 95401-4687 - Phone
- (707) 529-0220
- NPI assigned
- Sep 28, 2012
- 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 | 93544 | CA | Primary |
Addresses
Primary practice location
1360 N Dutton Ave
Ste. 100
Santa Rosa, CA 95401-4687
Mailing address
PO Box 375
Petaluma, CA 94953-0375
Phone (707) 529-0220
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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93544 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1699026765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 375",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949530375",
"telephone_number": "707-529-0220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 N DUTTON AVE",
"address_2": "STE. 100",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954014687",
"telephone_number": "707-529-0220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASTRUP",
"first_name": "AMANDA",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "MA, LMFT 93544",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "93544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.