Individual provider Active NPI

Nadine Lynn Hendricks, LCSW

  • Clinical Social Worker
  • Diamond Springs, CA
National Provider Identifier
1053828004
Registry record updated Dec 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
66251 Issued in CA
Practice address
768 Pleasant Valley Rd
Diamond Springs, CA 95619-9260
Phone
(530) 621-6290
NPI assigned
Dec 29, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW66251 CA
Clinical Social Worker 1041C0700X 66251 CA Primary

Addresses

Primary practice location

768 Pleasant Valley Rd
Diamond Springs, CA 95619-9260

Mailing address

5891 Puerta del Sol
Camino, CA 95709-9140
Phone (530) 363-8316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCSW66251CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
El Dorado County Mental Health Past Accepting new patients
El Dorado County Mental Health Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514505600000",
    "number": "1053828004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5891 PUERTA DEL SOL",
            "city": "CAMINO",
            "state": "CA",
            "postal_code": "957099140",
            "telephone_number": "530-363-8316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 PLEASANT VALLEY RD",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199260",
            "telephone_number": "530-621-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "NADINE",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-29",
        "last_updated": "2017-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW66251",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "66251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamond Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; 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.