Active NPI
Brooke Michelle Nielsen, MFT INTERN
- Marriage & Family Therapist
- Solana Beach, CA
National Provider Identifier
1396023982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 53345
- Practice address
- 312 S. Cedros Ave. Ste 334
Ste. 304
Solana Beach, CA 92107 - Phone
- (858) 876-5043
- NPI assigned
- Jul 29, 2011
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 53345 | CA | Primary |
Addresses
Primary practice location
312 S. Cedros Ave. Ste 334
Ste. 304
Solana Beach, CA 92107
Mailing address
2089 Chatsworth Blvd Apt 7
San Diego, CA 92107-2740
Phone (858) 876-5043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 28, 2024 through Mar 28, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53345 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392163200000",
"number": "1396023982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2089 CHATSWORTH BLVD APT 7",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921072740",
"telephone_number": "858-876-5043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 S. CEDROS AVE. STE 334",
"address_2": "STE. 304",
"city": "SOLANA BEACH",
"state": "CA",
"postal_code": "92107",
"telephone_number": "858-876-5043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "BROOKE",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "MFT INTERN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-29",
"last_updated": "2014-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "53345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Solana Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.