Healthcare Provider Details

I. General information

NPI: 1447797469
Provider Name (Legal Business Name): BRITTNEY ROSE FORTNER RADT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTNEY ROSE SHERNAMAN RADT-I

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 PALM AVE
RIVERSIDE CA
92501-4012
US

IV. Provider business mailing address

5870 ARLINGTON AVE SUITE 103
RIVERSIDE CA
92504-2037
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-0021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: