Active NPI
Frederick Elias Persiko, M DIV., CACITI
- Social Worker
- Basalt, CO
National Provider Identifier
1730320557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6807010854
- Practice address
- 23400 Two Rivers Road
#49
Basalt, CO 81621 - Phone
- (970) 927-5357
- Fax
- (970) 927-3467
- NPI assigned
- Mar 9, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2810 | CO | |
| Social Worker | 104100000X | 6807010854 | MI | Primary |
Addresses
Primary practice location
23400 Two Rivers Road
#49
Basalt, CO 81621
Mailing address
P.O. Box 138
Basalt, CO 81621
Phone (970) 927-5357
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 |
|---|---|---|---|
| 2810 | CO | MD | Addiction (Substance Use Disorder) Counselor |
| 6807010854 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1730320557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 138",
"city": "BASALT",
"state": "CO",
"postal_code": "81621",
"telephone_number": "970-927-5357",
"fax_number": "970-927-3467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23400 TWO RIVERS ROAD",
"address_2": "#49",
"city": "BASALT",
"state": "CO",
"postal_code": "81621",
"telephone_number": "970-927-5357",
"fax_number": "970-927-3467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSIKO",
"first_name": "FREDERICK",
"middle_name": "ELIAS",
"name_prefix": "Mr.",
"credential": "M DIV., CACITI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-09",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "2810",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6807010854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Basalt, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.