Provider Demographics
NPI:1447797469
Name:FORTNER, BRITTNEY ROSE (RADT-I)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:ROSE
Last Name:FORTNER
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:ROSE
Other - Last Name:SHERNAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADT-I
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4750 PALM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4012
Practice Address - Country:US
Practice Address - Phone:951-686-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)