Active NPI
Ilene Fava
- Clinical Social Worker
- Riverside, CA
National Provider Identifier
1104746221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ASW139398
- Practice address
- 12514 Harlow Ave
Riverside, CA 92503-4705 - Phone
- (951) 543-7760
- NPI assigned
- Jul 18, 2026
- 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 | ASW139398 | CA | Primary |
Addresses
Primary practice location
12514 Harlow Ave
Riverside, CA 92503-4705
Mailing address
12514 Harlow Ave
Riverside, CA 92503-4705
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784332800000",
"number": "1104746221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12514 HARLOW AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925034705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12514 HARLOW AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925034705",
"telephone_number": "951-543-7760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVA",
"first_name": "ILENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-07-18",
"last_updated": "2026-07-18",
"certification_date": "2026-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW139398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.