Ismael Edge Gerena Jr., MA, LMHCA, LMFTA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC60449151 Issued in WA

Practice address

901 Boren Ave
Suite 1015
Seattle, WA 98104-3595

Phone

(206) 801-3555

Fax

(206) 801-3264

NPI assigned

Apr 18, 2014

Last updated

Jul 2, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Indigo Mental Health PLLC

  dba Indigo Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Seattle, WA
  • NPI 1578963732
  Authorized official Same address or phone

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1821418633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 BOREN AVE",
            "address_2": "SUITE 1015",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043595",
            "telephone_number": "425-591-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BOREN AVE",
            "address_2": "SUITE 1015",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043595",
            "telephone_number": "206-801-3555",
            "fax_number": "206-801-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERENA",
        "first_name": "ISMAEL",
        "middle_name": "EDGE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MA, LMHCA, LMFTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-18",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60449151",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "MG60449387",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicola Rose Gerbino
• Ashley Mitchell Gerboth, PA-C
• Devin Gerboth
• Rachael Marie Gerboth
• Jennifer Gerdts
• Maureen Gerety, RN
• Jeffrey J Gerhardstein, LICSW
• Gretchen Gerhardt, LMHCA
• Samantha Gerlach, DDS
• Sara W Gerlach, DNP, ARNP

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.

Verify at the official NPI Registry.