Active NPI
Brandon Michael Robertson, CAS
- Addiction (Substance Use Disorder) Counselor
- Fresno, CA
National Provider Identifier
1629134598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 02-075241
- Practice address
- 125 E Dakota Ave Apt 104
Fresno, CA 93704-4073 - Phone
- (559) 375-5487
- NPI assigned
- Dec 28, 2006
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 02-075241 | CA | Primary |
Addresses
Primary practice location
125 E Dakota Ave Apt 104
Fresno, CA 93704-4073
Mailing address
125 E Dakota Ave Apt 104
Fresno, CA 93704-4073
Phone (559) 375-5487
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02-075241 | Other | CA | CAARR |
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 |
|---|---|---|---|
| 02-075241 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198800000000",
"number": "1629134598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E DAKOTA AVE APT 104",
"city": "FRESNO",
"state": "CA",
"postal_code": "937044073",
"telephone_number": "559-375-5487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E DAKOTA AVE APT 104",
"city": "FRESNO",
"state": "CA",
"postal_code": "937044073",
"telephone_number": "559-375-5487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "BRANDON",
"middle_name": "MICHAEL",
"credential": "CAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "02-075241",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAARR",
"identifier": "02-075241",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.