Active NPI
Grady Michael Fort, L.M.F.T.
- Marriage & Family Therapist
- Berkeley, CA
National Provider Identifier
1588099568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 90047
- Practice address
- 2955 Shattuck Ave Ste 9
Berkeley, CA 94705-1808 - Phone
- (510) 500-5231
- NPI assigned
- Sep 9, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 90047 | CA | Primary |
Addresses
Primary practice location
2955 Shattuck Ave Ste 9
Berkeley, CA 94705-1808
Mailing address
2955 Shattuck Ave Ste 9
Berkeley, CA 94705-1808
Phone (510) 500-5231
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 |
|---|---|---|---|
| 90047 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465171200000",
"number": "1588099568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2955 SHATTUCK AVE STE 9",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051808",
"telephone_number": "510-500-5231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2955 SHATTUCK AVE STE 9",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051808",
"telephone_number": "510-500-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORT",
"first_name": "GRADY",
"middle_name": "MICHAEL",
"credential": "L.M.F.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-09",
"last_updated": "2016-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "90047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.