STANLEY BRAGG JR. (NPI# 1013368083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013368083 |
| Entity Type | Individual |
| Full Name | STANLEY BRAGG JR. |
| Practice Address |
6119 Montecito Blvd Apt 12 Santa Rosa CA 95409-2969 |
| Practice Telephone | 7078882592 |
| Mailing Telephone | 7078882592 |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
7744-R | CA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | SUBSTANCE ABUSE COUNSELOR | 7744-R | 01 |
| Street Address |
6119 MONTECITO BLVD APT 12 |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95409-2969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568005205 | Angela Tejeda | Counselor | 35555 Sonoma Hwy, Santa Rosa, CA 95409 | 2019-10-25 |
| 1609335314 | Heidi Diebel | Marriage & Family Therapist | 9291 Oak Trail Cir, Santa Rosa, CA 95409 | 2019-03-13 |
| 1427525328 | Christopher William Schouest | Behavioral Analyst | 5424 Sharon St., Santa Rosa, CA 95409 | 2018-10-29 |
| 1194178756 | Ana Ceniceros | Registered Nurse | 7425 Los Guilucos Rd, Santa Rosa, CA 95409 | 2016-07-19 |
| 1669842878 | Kimberly Harris | Counselor | 7425 Los Guilicos Rd., Dept. H, Santa Rosa, CA 95409 | 2015-09-30 |
| 1568884849 | Christopher Cincotta | Counselor | 540 Middle Rincon Road, Santa Rosa, CA 95409 | 2014-01-06 |
| 1104186626 | Gina Ruth Sarpy | Marriage & Family Therapist | 7425 Los Guilicos Rd, Dept. H, Santa Rosa, CA 95409 | 2012-05-17 |
| 1467745950 | Courtney King | Family Medicine | 4702 Starbuck Ave, Santa Rosa, CA 95409 | 2011-05-17 |
| 1427351162 | Robert E Richardson Md Professional Corp. | Surgery | 1812 Happy Valley Road, Santa Rosa, CA 95409 | 2010-12-20 |
| 1497063564 | Edmundo Simon Martinez IIi IIi | Occupational Therapist | 5555 Montgomery Dr., Santa Rosa, CA 95409 | 2010-09-22 |
| Find all providers in zip 95409 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568089803 | Joan Colombo | Counselor | 1450 Neotomas Ave, Santa Rosa, CA 95405-7537 | 2020-07-02 |
| 1083230486 | Lizett Camacho | Counselor | 145o Neotomas Avenue Suite 200, Santa Rosa, CA 95405 | 2020-06-22 |
| 1568005205 | Angela Tejeda | Counselor | 35555 Sonoma Hwy, Santa Rosa, CA 95409 | 2019-10-25 |
| 1780147538 | Aimee Noelle Krzywicki | Counselor | 2403 Professional Dr Ste 102, Santa Rosa, CA 95403-3007 | 2019-04-09 |
| 1811487903 | Michael Armand Maritzen | Counselor | 2245 Challenger Way # 100, Santa Rosa, CA 95407-5418 | 2018-05-14 |
| 1922520527 | Robert John Lotero | Counselor | 7104 Oak Leaf Dr, Santa Rosa, CA 95409-6028 | 2017-07-14 |
| 1184153728 | Amanda Christina Gomez-hernandez | Counselor | 2400 County Center Dr Ste B, Santa Rosa, CA 95403-3004 | 2017-06-07 |
| 1225577968 | Kari Kenyon | Counselor | 1380 Wright St Apt 8, Santa Rosa, CA 95404-3437 | 2017-02-14 |
| 1205207321 | Flaman Craig Mccloud Jr. | Counselor | 440 Arrowood Dr., Santa Rosa, CA 95407 | 2015-10-15 |
| 1124497458 | Dallas Jones | Counselor | 2403 Professional Dr Ste 103, Santa Rosa, CA 95403-3007 | 2015-09-16 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95409 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.