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MRS. SHANNON RENEE VANDERBERG
NPI 1306073952
Marriage & Family Therapist in Reseda, CA

Active since June 22, 2009PECOS Enrolled
19231 VICTORY BLVD STE 110, RESEDA, CA 91335(818) 708-4500(818) 654-1956 Get Directions Write a Review

NPPES record last updated: March 17, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 17, 2018, Dec 13, 2017, Nov 30, 2015 (3 updates tracked since 2015).

About Mrs. Shannon Renee Vanderberg NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. SHANNON RENEE VANDERBERG (NPI 1306073952) is an individual marriage & family therapist in Reseda, California, licensed in California (MFC90568) and active in the NPI registry since June 2009. She is enrolled in Medicare PECOS and maintains a secondary practice location in Los Angeles.

NPPES Registry Identity

NPI1306073952
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameMRS. SHANNON RENEE VANDERBERG
Location Address19231 VICTORY BLVD STE 110Reseda, CA 91335-6321
Mailing Address19231 Victory Blvd Ste 110Reseda, CA 91335-6321 · (818) 708-4500 · Fax (818) 654-1956
Phone(818) 708-4500
Fax(818) 654-1956
Sole ProprietorYes
Enumeration DateJune 22, 2009
Last NPPES UpdateMarch 17, 20183 updates tracked since enumeration
✔ NPI 1306073952 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · MFC90568
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
19231 VICTORY BLVD STE 110, Reseda, CA 91335
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Other Names 1

Former Name (1)Ms. Shannon Renee Washington

Secondary Practice Location 1

Location 17003 North Figueroa St.Los Angeles, CA 90041-6418 · Phone (323) 543-4233 · Fax (323) 344-7382

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Shannon Renee Vanderberg is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shannon Vanderberg reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Grow Healthcare Group PC
287 mi
Mental Health
99 S ALMADEN BLVD STE 600
San Jose, CA 95113
  • Reassigned Medicare billing, California enrollment
  • 3,139 clinicians in this Medicare group
NPI 1154994846 (408) 402-4385

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CINDY JONG PSY.D.
Psychologist
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
MS. SANA KHOURI
Counselor (Professional)
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
VANESSA LINARES
Rehabilitation Practitioner
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
CHRISTINA L NADEL PSY.D.
Psychologist (Clinical)
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
OLABISI OYEWO
Psychologist (Clinical Child & Adolescent)
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
DR. MEREDITH A HANNAN MD, PHD
Psychiatry & Neurology (Child & Adolescent Psychiatry)
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
MS. DEBRA JILL GREEN M.A., LMFT
Marriage & Family Therapist
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500
RICHIE PHU WONG PSY.D.
Psychologist (Clinical)
19231 VICTORY BLVD STE 110
RESEDA, CA 91335
Los Angeles County (818) 708-4500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Vanderberg's NPI number?

The NPI number for Shannon Vanderberg is 1306073952. It was assigned to this individual provider in the NPPES registry on June 22, 2009. The provider is also known as Ms. Shannon Renee Washington.

Where is Shannon Vanderberg located?

Shannon Vanderberg practices at 19231 Victory Blvd Ste 110, Reseda, CA 91335. The listed phone number is (818) 708-4500.

What is Shannon Vanderberg's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Shannon Vanderberg enrolled in Medicare?

Yes. Shannon Vanderberg is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Shannon Vanderberg's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shannon Vanderberg reassigns Medicare benefits to Grow Healthcare Group PC (San Jose, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shannon Vanderberg's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shannon Vanderberg was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.