Active NPI
Anthony Aadolphus Lord I
- Peer Specialist
- Novato, CA
National Provider Identifier
1376070490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-CAZSPQ
- Practice address
- 1140 Elm Dr Apt 3
Novato, CA 94945-3133 - Phone
- (415) 320-2489
- Fax
- (415) 492-0834
- NPI assigned
- May 19, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Peer Specialist | 175T00000X | MPSS-CAZSPQ | CA | Primary |
Addresses
Primary practice location
1140 Elm Dr Apt 3
Novato, CA 94945-3133
Mailing address
1140 Elm Dr Apt 3
Novato, CA 94945-3133
Phone (415) 320-2489
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N5836204 | Medicaid | CA |
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 |
|---|---|---|---|
| MPSS-CAZSPQ | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754265600000",
"number": "1376070490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 ELM DR APT 3",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453133",
"telephone_number": "415-320-2489",
"fax_number": "415-492-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 ELM DR APT 3",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453133",
"telephone_number": "415-320-2489",
"fax_number": "415-492-0834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORD",
"first_name": "ANTHONY",
"middle_name": "AADOLPHUS",
"name_suffix": "I",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-19",
"last_updated": "2025-08-04",
"certification_date": "2025-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-CAZSPQ",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N5836204",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.