Active NPI
Jacqueline Sophie Bonivel
- Marriage & Family Therapist
- Concord, CA
National Provider Identifier
1912575770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 1200 Concord Ave Ste 450
Concord, CA 94520-4959 - Phone
- (925) 933-2627
- NPI assigned
- Jun 16, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
1200 Concord Ave Ste 450
Concord, CA 94520-4959
Mailing address
1200 Concord Ave Ste 450
Concord, CA 94520-4959
Phone (925) 933-2627
Other practice location 1
15750 Foothill Blvd
San Leandro, CA 94578-1012
Phone (510) 667-3952
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth Homes, Inc. | Current | Accepting new patients | |
| Healthy Mind World | Current | Accepting new patients |
Locations
1200 Concord Ave
Ste 450
Concord, CA 94520
Phone (925) 286-5684
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Concord, CA
- NPI 1740326750
-
- Psychiatry Physician
- Allen, TX
- NPI 1144741521
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1912575770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 450",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204959",
"telephone_number": "925-933-2627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 450",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204959",
"telephone_number": "925-933-2627"
}
],
"practiceLocations": [
{
"address_1": "15750 Foothill Blvd",
"address_purpose": "LOCATION",
"city": "San Leandro",
"state": "CA",
"postal_code": "945781012",
"country_code": "US",
"telephone_number": "510-667-3952",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BONIVEL",
"first_name": "JACQUELINE",
"middle_name": "SOPHIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.