Active NPI
Jerwyn Carriger Sendaydiego, M.A., P.P.S, M.F.T.I
- Mental Health Counselor
- Fairfield, CA
National Provider Identifier
1770816209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 88338
- Practice address
- 801 Empire St
Fairfield, CA 94533-5702 - Phone
- (707) 400-3790
- NPI assigned
- Sep 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | IMF 60710 | CA | |
| Mental Health Counselor | 101YM0800X | 88338 | CA | Primary |
Addresses
Primary practice location
801 Empire St
Fairfield, CA 94533-5702
Mailing address
801 Empire St
Fairfield, CA 94533-5702
Phone (707) 425-5744
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YM0800X | Other | CA | COUNSELOR, MENTAL HEALTH |
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 |
|---|---|---|---|
| 88338 | CA | MD | Mental Health Counselor |
| IMF 60710 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449532800000",
"number": "1770816209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335702",
"telephone_number": "707-425-5744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335702",
"telephone_number": "707-400-3790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SENDAYDIEGO",
"first_name": "JERWYN",
"middle_name": "CARRIGER",
"name_prefix": "Mr.",
"credential": "M.A., P.P.S, M.F.T.I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-16",
"last_updated": "2015-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF 60710",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "88338",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELOR, MENTAL HEALTH",
"identifier": "101YM0800X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.