Individual provider Active NPI

Kristie L Brandt

  • Clinical Psychologist
  • Fort Lauderdale, FL
National Provider Identifier
1871009100
Registry record updated Dec 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY9805 Issued in FL
Practice address
1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875
Phone
(954) 885-9500
Fax
(954) 885-9444
NPI assigned
Dec 22, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY9805 FL Primary

Addresses

Primary practice location

1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875

Mailing address

1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875
Phone (954) 885-9500

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

LicenseStateTypeSpecialty
PY9805FLMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513900800000",
    "number": "1871009100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 SE 1ST AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162875",
            "telephone_number": "954-885-9500",
            "fax_number": "954-885-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 SE 1ST AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162875",
            "telephone_number": "954-885-9500",
            "fax_number": "954-885-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "KRISTIE",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-22",
        "last_updated": "2017-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2017; 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.