Active NPI
Brandon Dearen, PSYD
- Psychologist
- Long Beach, CA
National Provider Identifier
1629324249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2020
- Practice address
- 121 W Victoria St
Long Beach, CA 90805-2162 - Phone
- (310) 603-1050
- NPI assigned
- Aug 1, 2012
- Reactivated
- Mar 18, 2020
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2020 | AL | Primary |
Addresses
Primary practice location
121 W Victoria St
Long Beach, CA 90805-2162
Mailing address
2093 Kirkman Dr
Birmingham, AL 35242-4639
Phone (205) 848-2750
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020 | AL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alabama Testing and Learning Center, LLC | Psychologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Homewood, AL
- NPI 1427603117
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584489600000",
"number": "1629324249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2093 KIRKMAN DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352424639",
"telephone_number": "205-848-2750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 W VICTORIA ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908052162",
"telephone_number": "310-603-1050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAREN",
"first_name": "BRANDON",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-01",
"last_updated": "2020-03-18",
"certification_date": "2020-03-18",
"deactivation_date": "2018-08-26",
"reactivation_date": "2020-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AL",
"license": "2020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.