Provider Demographics
NPI:1043670995
Name:BLACKSMITH, NATHAN REUBEN (CADCII)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:REUBEN
Last Name:BLACKSMITH
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 ARCHER DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5607
Mailing Address - Country:US
Mailing Address - Phone:415-865-0964
Mailing Address - Fax:415-865-5428
Practice Address - Street 1:56 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3507
Practice Address - Country:US
Practice Address - Phone:415-865-0964
Practice Address - Fax:415-865-5428
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA02670315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)