MEDICARE: MS. EVANGELINA ADRIA MADRID-KERR CADCII, MPSS, CMHRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	A09940315	CA
2	175T00000X	Peer Specialist	MPSS-SGMWUK	CA
3	373H00000X	Day Training/Habilitation Specialist	20-SMHRS-00015	CA
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	A09940315	CA

General Provider Information

NPI Number	:	1336430206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVANGELINA ADRIA MADRID-KERR CADCII, MPSS, CMHRS

Provider Business Mailing Address
First Line	:	14238 SARANAC LN
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1435
Country	:	US
Telephone Number	:	661-607-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	14238 SARANAC LN
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1435
Country	:	US
Telephone Number	:	661-607-8664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	08/27/2025

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