Active NPI
Brett Andersen, PSYD
- Clinical Neuropsychologist
- Phoenix, AZ
National Provider Identifier
1386172732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 4845
- Practice address
- 300 W Clarendon Ave Ste 130
Phoenix, AZ 85013-3421 - Phone
- (602) 300-1508
- NPI assigned
- May 30, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 4845 | AZ | Primary |
Addresses
Primary practice location
300 W Clarendon Ave Ste 130
Phoenix, AZ 85013-3421
Mailing address
11445 E Via Linda
Suite 2, PMB 473
Scottsdale, AZ 85259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4845 | AZ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496102400000",
"number": "1386172732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11445 E VIA LINDA",
"address_2": "SUITE 2, PMB 473",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "85259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W CLARENDON AVE STE 130",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850133421",
"telephone_number": "602-300-1508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "BRETT",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-30",
"last_updated": "2017-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "AZ",
"license": "4845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.