Individual provider Active NPI

Matthew Long

  • Professional Counselor
  • Santa Rosa, CA
National Provider Identifier
1457879587
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
3371 Parker Hill Rd
Santa Rosa, CA 95404-1732
Phone
(707) 535-0289
NPI assigned
Sep 8, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

3371 Parker Hill Rd
Santa Rosa, CA 95404-1732

Mailing address

368 Fell St
San Francisco, CA 94102-5144
Phone (415) 861-0828

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1457879587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 FELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025144",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3371 PARKER HILL RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041732",
            "telephone_number": "707-535-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-08",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.