Individual provider Active NPI

Jonathan Haidak, PSY.D.

  • Mental Health Counselor
  • San Diego, CA
National Provider Identifier
1982085346
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
734 10TH Ave
San Diego, CA 92101-6502
Phone
(619) 239-4663
NPI assigned
Jun 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

734 10TH Ave
San Diego, CA 92101-6502

Mailing address

734 10TH Ave
San Diego, CA 92101-6502
Phone (619) 239-4663

Other practice location 1

892 27th St
San Diego, CA 92154-1444
Phone (619) 575-4687

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

OrganizationSpecialtyStatusNew patients
Community Research Foundation Inc PastSince Jul 25, 2019 Accepting new patients
Community Research Foundation Inc PastSince Jul 25, 2019 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1982085346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 10TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016502",
            "telephone_number": "619-239-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "734 10TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016502",
            "telephone_number": "619-239-4663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "892 27th St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921541444",
            "country_code": "US",
            "telephone_number": "619-575-4687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAIDAK",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "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 Jul 15, 2019; 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.