Active NPI
Mary Ellen Tanner, LCSW
- Clinical Social Worker
- Covina, CA
National Provider Identifier
1063767796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW73551
- Practice address
- 4740 N Grand Ave
Covina, CA 91724-2005 - Phone
- (626) 859-2089
- Fax
- (626) 859-6537
- NPI assigned
- Jul 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW73551 | CA | Primary |
Addresses
Primary practice location
4740 N Grand Ave
Covina, CA 91724-2005
Mailing address
4740 N Grand Ave
Covina, CA 91724-2005
Phone (626) 859-2089
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW73551 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480982400000",
"number": "1063767796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4740 N GRAND AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917242005",
"telephone_number": "626-859-2089",
"fax_number": "626-859-6537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 N GRAND AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917242005",
"telephone_number": "626-859-2089",
"fax_number": "626-859-6537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-18",
"last_updated": "2016-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW73551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.