Brody Louis Dwyer

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-KQHMIJ Issued in CA

Practice address

10038 Meadow Way Unit D
Truckee, CA 96161-4974

Phone

(530) 536-6693

NPI assigned

Aug 18, 2023

Last updated

Mar 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1720862089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10038 MEADOW WAY UNIT D",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614974",
            "telephone_number": "530-536-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10038 MEADOW WAY UNIT D",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614974",
            "telephone_number": "530-536-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWYER",
        "first_name": "BRODY",
        "middle_name": "LOUIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-18",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-KQHMIJ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Truckee, CA
• Providers in Truckee, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.