SUD SPECIALTY GROUP - CA (NPI# 1972138238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972138238 |
| Entity Type | Organization |
| Organization Name | SUD SPECIALTY GROUP - CA |
| Practice Address |
520 Broadway Ste 200 Santa Monica CA 90401-2470 |
| Practice Telephone | 3232057088 |
| Mailing Telephone | 3232057088 |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-17 |
| Authorized Official Name | MARK WILLENBRING (CEO) |
| Authorized Official Telephone | 3232057088 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 103TC1900X |
Psychologist Specialization: Counseling |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
520 BROADWAY STE 200 |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90401-2470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013499458 | Franchesca Johnson Gordon | Marriage & Family Therapist | 900 Wilshire Blvd., Ste. 450, Santa Monica, CA 90401 | 2018-09-01 |
| 1629564083 | Michelle Jillian Dolinsky | Social Worker | 1243 7th St Ste C, Santa Monica, CA 90401 | 2018-07-09 |
| 1528507084 | Doctor Tlc, License Clinical Psychologist, Inc. | Community/Behavioral Health | 1242 Third St Promenade, Suite 208, Santa Monica, CA 90401 | 2017-02-16 |
| 1285006023 | Venessa Leeann Roca | Speech-Language Pathologist | 1218 6th Street, Santa Monica, CA 90401 | 2015-10-20 |
| 1720468036 | Stephen J. Kenneally | Marriage & Family Therapist | 610 Santa Monica Bvd, Ste. 201, Santa Monica, CA 90401 | 2015-06-02 |
| 1629458070 | Dominique L Robertson | Marriage & Family Therapist | 530 Wilshire, #310, Santa Monica, CA 90401 | 2015-06-01 |
| 1205252673 | Santa Monica Sports Medicine Inc. | Physical Medicine & Rehabilitation | 900 Wilshire Blvd. #410, Santa Monica, CA 90401 | 2014-03-10 |
| 1154675023 | Sherry Marie Martyn | Psychologist | 1242 3rd Street Promenade Ste 208, Santa Monica, CA 90401 | 2012-10-31 |
| 1700159829 | Gary Warburton | Dentist | 519 Arizona Ave., Santa Monica, CA 90401 | 2012-02-21 |
| 1265713036 | Aleksandr Mailyan | Reflexologist | 201 Wilshire Blvd #101, Santa Monica, CA 90401 | 2011-09-07 |
| Find all providers in zip 90401 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881736635 | Richard Stephen Sandor | Psychiatry & Neurology | 2665 30th Street, Suite 216, Santa Monica, CA 90405-3063 | 2007-02-12 |
| 1124644166 | Moment Health | Psychiatry & Neurology | 2730 Wilshire Blvd Ste 350, Santa Monica, CA 90403-4752 | 2020-06-24 |
| 1386938082 | Matthew Goldenberg | Psychiatry & Neurology | 2515 Wilshire Blvd, Santa Monica, CA 90403-4615 | 2011-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992319560 | Blossoming Wellbeing Telepsychiatry | Psychiatry & Neurology | 5455 8th St Unit 81, Carpinteria, CA 93013-2433 | 2020-09-01 |
| 1962028936 | Sal Psychiatry Services | Psychiatry & Neurology | 13132 Studebaker Rd Ste 7, Norwalk, CA 90650-2562 | 2020-06-24 |
| 1932768280 | Sprenger Behavioral Medicine, Inc | Psychiatry & Neurology | 7601 Hospital Drive Suite 202, Suite 202, Sacramento, CA 95823 | 2019-06-11 |
| 1609431014 | Vaya Addiction Services | Psychiatry & Neurology | 945 University Ave Ste 101, Sacramento, CA 95825-6712 | 2019-05-01 |
| 1174081327 | Bacchus, Moghaddam, Musngi, Shwayder Medical Corp. | Psychiatry & Neurology | 6801 Park Ter # 530b, Los Angeles, CA 90045-1543 | 2019-03-06 |
| 1104330570 | Integrated Psychiatry, Inc. | Psychiatry & Neurology | 25000 Avenue Stanford Ste 173, Valencia, CA 91355-4596 | 2017-11-21 |
| 1740689694 | Mind & Body Treatment and Research Institute, PC | Psychiatry & Neurology | 5700 Division St, 200, Riverside, CA 92506-3257 | 2014-08-16 |
| 1619311206 | Margaret Barnett Yates | Psychiatry & Neurology | 13847 W Sunset Blvd, Pacific Palisades, CA 90272-4023 | 2013-04-25 |
| 1750645743 | Stefani Lafrenierre | Psychiatry & Neurology | 215 S Hickory St Ste 114, Escondido, CA 92025-4360 | 2012-06-25 |
| 1083977201 | Archangel De Leon | Psychiatry & Neurology | 7466 Sun Castle Ln, Sacramento, CA 95823-6734 | 2012-06-21 |
| Find all providers with the same taxonomy | ||||
| City | SANTA MONICA |
| Zip Code | 90401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.