Active NPI
Forrest Hansen, RBT
- Behavior Technician
- Petaluma, CA
National Provider Identifier
1639670797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-17-45811
- Practice address
- 101 H St Ste L
Petaluma, CA 94952-5100 - Phone
- (866) 206-2008
- Fax
- (866) 317-1665
- NPI assigned
- Feb 23, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-17-45811 | CA | Primary |
Addresses
Primary practice location
101 H St Ste L
Petaluma, CA 94952-5100
Mailing address
500 Sonoma Ave Apt I
Santa Rosa, CA 95401-6361
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 |
|---|---|---|---|
| RBT-17-45811 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519344000000",
"number": "1639670797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SONOMA AVE APT I",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 H ST STE L",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949525100",
"telephone_number": "866-206-2008",
"fax_number": "866-317-1665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "FORREST",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-23",
"last_updated": "2018-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "RBT-17-45811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.