Active NPI
Brenda L Rider, CASAC
- Addiction (Substance Use Disorder) Counselor
- Waterloo, NY
National Provider Identifier
1215162482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 19425
- Practice address
- 31 Thurber Dr
Waterloo, NY 13165-1649 - Phone
- (315) 539-1985
- Fax
- (315) 539-4393
- NPI assigned
- May 18, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19425 | NY | Primary |
Addresses
Primary practice location
31 Thurber Dr
Waterloo, NY 13165-1649
Mailing address
31 Thurber Dr
Waterloo, NY 13165-1649
Phone (315) 539-1985
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19425 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242604800000",
"number": "1215162482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 THURBER DR",
"city": "WATERLOO",
"state": "NY",
"postal_code": "131651649",
"telephone_number": "315-539-1985",
"fax_number": "315-539-4393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 THURBER DR",
"city": "WATERLOO",
"state": "NY",
"postal_code": "131651649",
"telephone_number": "315-539-1985",
"fax_number": "315-539-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDER",
"first_name": "BRENDA",
"middle_name": "L",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-18",
"last_updated": "2009-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "19425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.