Charles Anderson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

110738 Issued in CA

Practice address

825 Webster St Ste D
Fairfield, CA 94533-5522

Phone

(707) 386-8066

Fax

(707) 673-2800

NPI assigned

Apr 24, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• My Niche Family Therapy Professional Corporation

  • Marriage & Family Therapist
  • Fairfield, CA
  • NPI 1801755269
  NPD Authorized official

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

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1790172013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 WEBSTER ST STE D",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335522",
            "telephone_number": "707-386-8066",
            "fax_number": "707-447-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 WEBSTER ST STE D",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335522",
            "telephone_number": "707-386-8066",
            "fax_number": "707-673-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-24",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "110738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nail Amro, M.D.
• Marc Benjamin Anacta, CORECHI
• Bernadette Tesorero Ancheta, DDS
• Brianna Lizette Anderson
• Brianna Shantice Anderson
• Gabrielle Anderson, RNC-OB, BSN, PHN
• John David Anderson, M.D.
• Lisa M Anderson, SLP
• Lydell Anderson, M.D.
• Mark Wayne Anderson, DDS

• Marriage & Family Therapist in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.