Carla E Fadriquela, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L7861 Issued in OR

Practice address

2980 SW 123Rd Ave
Beaverton, OR 97005-1325

Phone

(808) 281-4616

NPI assigned

Feb 25, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Carla E McGuire Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shearwater Counseling Services

  • Clinical Social Worker
  • Portland, OR
  • NPI 1467011577
  NPD (past) Authorized official

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

{
    "created_epoch": "1551052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1003373101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 SW 123RD AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051325",
            "telephone_number": "808-281-4616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 SW 123RD AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051325",
            "telephone_number": "808-281-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADRIQUELA",
        "first_name": "CARLA",
        "middle_name": "E",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-25",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-4328",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLA",
            "last_name": "MCGUIRE",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.