Active NPI
Stacy Lynn Fazio, LCSW
- Clinical Social Worker
- Clovis, CA
National Provider Identifier
1104261544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW19354
- Practice address
- 755 N Peach Ave Ste H14
Clovis, CA 93611-7264 - Phone
- (555) 999-7308
- Fax
- (559) 712-6282
- NPI assigned
- Apr 29, 2013
- Last updated
- Aug 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | LCSW19354 | CA | Primary |
Addresses
Primary practice location
755 N Peach Ave Ste H14
Clovis, CA 93611-7264
Mailing address
673 W Richmond Ave
Clovis, CA 93619-4825
Phone (555) 999-7308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW19354 | CA | MD | Clinical Social Worker |
| 19354 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661644800000",
"number": "1104261544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "673 W RICHMOND AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936194825",
"telephone_number": "555-999-7308",
"fax_number": "559-712-6282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 N PEACH AVE STE H14",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936117264",
"telephone_number": "555-999-7308",
"fax_number": "559-712-6282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZIO",
"first_name": "STACY",
"middle_name": "LYNN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-29",
"last_updated": "2022-08-28",
"certification_date": "2022-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW19354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.