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JEANINE WONG
NPI 1639565104
Marriage & Family Therapist in Santa Rosa, CA

Active since April 12, 2015Opted out of Medicare · through Jan 1, 2028
3329 BONITA VISTA LANE, SANTA ROSA, CA 95404(707) 978-9209 Get Directions Write a Review

NPPES record last updated: June 15, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jeanine Wong NPPES

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

JEANINE WONG (NPI 1639565104) is an individual marriage & family therapist in Santa Rosa, California and active in the NPI registry since April 2015. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1639565104
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameJEANINE WONG
Location Address3329 BONITA VISTA LANESanta Rosa, CA 95404
Mailing Address3329 Bonita Vista LaneSanta Rosa, CA 95404 · (808) 754-8235
Phone(707) 978-9209
Sole ProprietorYes
Enumeration DateApril 12, 2015
Last NPPES UpdateJune 15, 2021
NPPES CertifiedJune 15, 2021
✔ NPI 1639565104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
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.
3329 BONITA VISTA LANE, Santa Rosa, CA 95404
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jeanine Wong has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

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 Jeanine Wong's NPI number?

The NPI number for Jeanine Wong is 1639565104. It was assigned to this individual provider in the NPPES registry on April 12, 2015.

Where is Jeanine Wong located?

Jeanine Wong practices at 3329 Bonita Vista Lane, Santa Rosa, CA 95404. The listed phone number is (707) 978-9209.

What is Jeanine Wong's specialty?

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

Is Jeanine Wong enrolled in Medicare?

No. Jeanine Wong has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jeanine Wong was last updated on June 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.