Active NPI
Audrey Gruen
- Social Worker
- Riverside, CA
National Provider Identifier
1164067567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 13328
- Practice address
- Canyon Crest Mental Health
5225 Canyon Crest Drive #100
Riverside, CA 92507 - Phone
- (951) 248-4000
- NPI assigned
- Nov 10, 2019
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 13328 | CA | Primary |
Addresses
Primary practice location
Canyon Crest Mental Health
5225 Canyon Crest Drive #100
Riverside, CA 92507
Mailing address
727 Euclid St
Santa Monica, CA 90402-2925
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCSW13328 | Medicaid | CA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | dreambabyinc@gmail.com | ||
| FHIR URL | scalcredriv@kp.ord |
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": "1573344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573344000000",
"number": "1164067567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 EUCLID ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904022925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CANYON CREST MENTAL HEALTH",
"address_2": "5225 CANYON CREST DRIVE #100",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92507",
"telephone_number": "951-248-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUEN",
"first_name": "AUDREY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-10",
"last_updated": "2019-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "13328",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LCSW13328",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "dreambabyinc@gmail.com",
"affiliation": "N",
"address_1": "Canyon Crest Mental Health",
"address_2": "5225 Canyon Crest Drive #100",
"city": "Riverside",
"state": "CA",
"country_code": "US",
"postal_code": "92507",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "scalcredriv@kp.ord",
"affiliation": "N",
"address_1": "Canyon Crest Mental Health",
"address_2": "5225 Canyon Crest Drive #100",
"city": "Riverside",
"state": "CA",
"country_code": "US",
"postal_code": "92507",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Nov 10, 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.