NPIMap

Organization Active NPI

Therapeutic Center for Anxiety and Trauma, Individual and Family Thera

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1770990657
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC49250 Issued in CA
Legal business name
THERAPEUTIC CENTER FOR ANXIETY AND TRAUMA, INDIVIDUAL AND FAMILY THERA
Practice address
2121 5TH Ave Ste 214
San Diego, CA 92101-2139
Phone
(619) 272-6858
NPI assigned
Jul 12, 2014
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Jennifer Costanza, LMFTNPI 1821185240
Title
Owner/President
Phone
(619) 272-6858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC49250 CA Primary

Addresses

Primary practice location

2121 5TH Ave Ste 214
San Diego, CA 92101-2139

Mailing address

2121 5TH Ave Ste 214
San Diego, CA 92101-2139
Phone (619) 272-6858

National Provider Directory

National Provider Directory

Locations

2121 5th Ave
Ste 214
San Diego, CA 92101
Phone (619) 272-6858

2121 5th Ave
Ste 3WEST
San Diego, CA 92101

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1405123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1770990657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 5TH AVE STE 214",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012139",
            "telephone_number": "619-272-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 5TH AVE STE 214",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012139",
            "telephone_number": "619-272-6858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC CENTER FOR ANXIETY AND TRAUMA, INDIVIDUAL AND FAMILY THERA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-12",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "COSTANZA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "619-272-6858",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC49250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.