Active NPI
Stephanie Nicole Sansom, MA
- Marriage & Family Therapist
- La Verne, CA
National Provider Identifier
1770729014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- IMF 58268
- Practice address
- 233 Base Line Rd
La Verne, CA 91750-2353 - Phone
- (909) 593-2581
- NPI assigned
- Dec 16, 2008
- 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 | IMF 58268 | CA | Primary |
Addresses
Primary practice location
233 Base Line Rd
La Verne, CA 91750-2353
Mailing address
PO Box 400
La Verne, CA 91750-0400
Phone (909) 593-2581
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF 58268 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229385600000",
"number": "1770729014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917500400",
"telephone_number": "909-593-2581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 BASE LINE RD",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917502353",
"telephone_number": "909-593-2581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANSOM",
"first_name": "STEPHANIE",
"middle_name": "NICOLE",
"name_prefix": "Ms.",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-16",
"last_updated": "2008-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF 58268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.