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140 S Cloverdale Blvd Cloverdale CA 95425-3710 | |
| (707) 894-4715 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 140 S Cloverdale Blvd, Cloverdale, California |
| Authorized Official Name and Position | Ruby Zhang (DEPARTMENT ANALYST) |
| Authorized Official Contact | 7075657846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5350 Old Redwood Highway, N Suite 600 Petaluma CA 94954-1177 Ph: (707) 894-4715 | 140 S Cloverdale Blvd Cloverdale CA 95425-3710 Ph: (707) 894-4715 |
| NPI Number | 1952637027 |
|---|---|
| Provider Enumeration Date | 10/26/2009 |
| Last Update Date | 12/06/2024 |
| Medicare PECOS PAC ID | 4688658651 |
|---|---|
| Medicare Enrollment ID | O20040616001152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952637027 | NPI | - | NPPES |
| 49FP | Other | CA | PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer P Beck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669523387 PECOS PAC ID: 5597655647 Enrollment ID: I20040319001247 |
| Provider Name | Tess M Lusher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548210099 PECOS PAC ID: 3072597087 Enrollment ID: I20040616001469 |
| Provider Name | Gary Bravo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669536009 PECOS PAC ID: 3678557592 Enrollment ID: I20040616001594 |
| Provider Name | Neil P Ehrlich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013078625 PECOS PAC ID: 2163401464 Enrollment ID: I20040719001651 |
| Provider Name | Murni Lubis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508962572 PECOS PAC ID: 8729030697 Enrollment ID: I20050218000574 |
| Provider Name | Marina Dsouza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851464739 PECOS PAC ID: 8628021656 Enrollment ID: I20050301001021 |
| Provider Name | Lennart H Moller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336224237 PECOS PAC ID: 3072560358 Enrollment ID: I20050407001357 |
| Provider Name | Michael Kozart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013060888 PECOS PAC ID: 1456392927 Enrollment ID: I20050513000814 |
| Provider Name | Shribala Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003934423 PECOS PAC ID: 1254359581 Enrollment ID: I20051104000798 |
| Provider Name | Danielle Marie Pyevich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689764029 PECOS PAC ID: 5092785964 Enrollment ID: I20060201000143 |
| Provider Name | Lynne A Love |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063450500 PECOS PAC ID: 9436254893 Enrollment ID: I20070413000500 |
| Provider Name | Clare L Maxwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548452519 PECOS PAC ID: 2961566682 Enrollment ID: I20090126000125 |
| Provider Name | Zoe Martinez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740319581 PECOS PAC ID: 9234280959 Enrollment ID: I20090619000189 |
| Provider Name | Diana L Verde |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235347576 PECOS PAC ID: 5395896278 Enrollment ID: I20090707000040 |
| Provider Name | Paul Mascovich |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1215921184 PECOS PAC ID: 5597775791 Enrollment ID: I20100504000194 |
| Provider Name | Mary Margaret Ewing |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073652004 PECOS PAC ID: 9739375346 Enrollment ID: I20101122000902 |
| Provider Name | Neal H Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659407823 PECOS PAC ID: 7911189824 Enrollment ID: I20110315000208 |
| Provider Name | Shyam A Kumbhani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124256904 PECOS PAC ID: 9133397367 Enrollment ID: I20110714000267 |
| Provider Name | Susan L Ahart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407924475 PECOS PAC ID: 8921268285 Enrollment ID: I20120322000678 |
| Provider Name | Nakul Varshney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942413463 PECOS PAC ID: 1052564895 Enrollment ID: I20130103000463 |
| Provider Name | Jill Rothberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811044407 PECOS PAC ID: 5496978512 Enrollment ID: I20140519000729 |
| Provider Name | Sophie Aneson-macleon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316007156 PECOS PAC ID: 0345463907 Enrollment ID: I20140529000453 |
| Provider Name | Sharmila Sinha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083817522 PECOS PAC ID: 1658465901 Enrollment ID: I20160919000642 |
| Provider Name | Lisa M Walker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154399723 PECOS PAC ID: 4082706890 Enrollment ID: I20161021001371 |
| Provider Name | Naga Kothapalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619301579 PECOS PAC ID: 4284934761 Enrollment ID: I20170628002707 |
| Provider Name | Angela Burt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992890222 PECOS PAC ID: 2567428618 Enrollment ID: I20170707000410 |
| Provider Name | Benjamin Ross Goldstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982915963 PECOS PAC ID: 2365660297 Enrollment ID: I20180207002747 |
| Provider Name | Katherine S Cole |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447469192 PECOS PAC ID: 1850487406 Enrollment ID: I20180208002959 |
| Provider Name | David Nichols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588933592 PECOS PAC ID: 0648531095 Enrollment ID: I20180227000765 |
| Provider Name | Stephanie Constantine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588108427 PECOS PAC ID: 4688911068 Enrollment ID: I20190123001557 |
| Provider Name | Matthew J Gardiner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629084710 PECOS PAC ID: 9133148794 Enrollment ID: I20190220002910 |
| Provider Name | Larissa A Pendergraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932404902 PECOS PAC ID: 6608107115 Enrollment ID: I20191015001956 |
| Provider Name | Kevin S Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225370885 PECOS PAC ID: 6103258751 Enrollment ID: I20191119003333 |
| Provider Name | Sunny Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548723422 PECOS PAC ID: 2769717396 Enrollment ID: I20200323001260 |
| Provider Name | Victoria I Ojiako |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508403551 PECOS PAC ID: 3971934910 Enrollment ID: I20200507002148 |
| Provider Name | Katie Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104375393 PECOS PAC ID: 9436562345 Enrollment ID: I20210114001698 |
| Provider Name | Oluseun Ofuje Ajayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114389178 PECOS PAC ID: 5193011591 Enrollment ID: I20210917002848 |
| Provider Name | Veronica Peinado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841772597 PECOS PAC ID: 3971900911 Enrollment ID: I20210917002878 |
| Provider Name | Thomas D Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346653664 PECOS PAC ID: 4981934163 Enrollment ID: I20220218002415 |
| Provider Name | Krutika Chokhawala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740743988 PECOS PAC ID: 1951630193 Enrollment ID: I20230614000715 |
| Provider Name | Cori L Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912600131 PECOS PAC ID: 4486015963 Enrollment ID: I20230731003677 |
| Provider Name | Amruta B Shanbhag |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295297083 PECOS PAC ID: 5597097063 Enrollment ID: I20231207003073 |
| Provider Name | Nohemi E Castaneda Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730503426 PECOS PAC ID: 8628514916 Enrollment ID: I20240723002183 |
| Provider Name | Sumiko N Booth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508926031 PECOS PAC ID: 7113463415 Enrollment ID: I20240723002497 |
| Provider Name | Aimee A Fouche |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1770985558 PECOS PAC ID: 5092251397 Enrollment ID: I20240723002651 |
| Provider Name | Brittany M Kesler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083040679 PECOS PAC ID: 7517403678 Enrollment ID: I20240724004487 |
| Provider Name | Brad Labass |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114548047 PECOS PAC ID: 2365988177 Enrollment ID: I20240729000477 |
| Provider Name | Johanna N Herron |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528460144 PECOS PAC ID: 2961949714 Enrollment ID: I20240730001817 |
| Provider Name | Kembly A Mahiri |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245713262 PECOS PAC ID: 5496292633 Enrollment ID: I20240805004217 |
| Provider Name | Rosa M Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811616634 PECOS PAC ID: 9931646981 Enrollment ID: I20240807004434 |
| Provider Name | Nitin M Kamble |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811214737 PECOS PAC ID: 9436456142 Enrollment ID: I20240813002939 |
| Provider Name | Jacob B Soled |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326693326 PECOS PAC ID: 8123566734 Enrollment ID: I20240814001922 |
| Provider Name | Todd A Hart |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134455710 PECOS PAC ID: 4082152541 Enrollment ID: I20240814004306 |
| Provider Name | Inderjeet Kaur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861815607 PECOS PAC ID: 5890928402 Enrollment ID: I20240820000453 |
| Provider Name | Caitlin S Butler |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1457964710 PECOS PAC ID: 1355880923 Enrollment ID: I20240827002462 |
| Provider Name | Marjorie L Darrow |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1851836902 PECOS PAC ID: 2365981651 Enrollment ID: I20240830001040 |
| Provider Name | Anikka L Goodman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972038198 PECOS PAC ID: 2365981669 Enrollment ID: I20240830001447 |
| Provider Name | Christina A Atkinson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1356753875 PECOS PAC ID: 4789125766 Enrollment ID: I20240917004875 |
| Provider Name | Desiree D Ohlstrom |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659670503 PECOS PAC ID: 8921532490 Enrollment ID: I20241107000621 |
| Provider Name | Sharilyn R Shaeffer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1558512418 PECOS PAC ID: 2466986807 Enrollment ID: I20241107003942 |
| Provider Name | Jo E Ihinger |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1962564500 PECOS PAC ID: 0840724175 Enrollment ID: I20241108003805 |
| Provider Name | Skylar R Lewis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134689862 PECOS PAC ID: 4486188711 Enrollment ID: I20241108003825 |
| Provider Name | Hasmig Tatiossian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659080695 PECOS PAC ID: 6608301197 Enrollment ID: I20241120003041 |
| Provider Name | Antonina Elizabeth C Selfridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891207650 PECOS PAC ID: 4082149588 Enrollment ID: I20241120003548 |
| Provider Name | Diana R Freedman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619175817 PECOS PAC ID: 4688109184 Enrollment ID: I20241120003734 |
| Provider Name | Christina S Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396159679 PECOS PAC ID: 0648523282 Enrollment ID: I20241212004063 |
| Provider Name | Thomas J Cooper |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720149081 PECOS PAC ID: 2860928892 Enrollment ID: I20241213000292 |
Alexander Valley Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6 Tarman Dr, Cloverdale, CA 95425 Phone: 707-894-4229 Fax: 707-894-2954 | |