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

Q: 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.

Q: What is Shannon Vanderberg's specialty?

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

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: August 09, 2026.

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

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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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