Sarah Marie Fanucci, LCSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

67568 Issued in TX

Practice address

4410 Dawn Ave
Odessa, TX 79762-5740

Phone

(360) 303-0958

NPI assigned

Apr 25, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1164166245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 DAWN AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625740",
            "telephone_number": "360-303-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 DAWN AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625740",
            "telephone_number": "360-303-0958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANUCCI",
        "first_name": "SARAH",
        "middle_name": "MARIE",
        "credential": "LCSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60822217",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "67568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerald Lavon Farber, M.D.
• Laura Farber, M.D.
• Masson Darwin Farmer, C.R.N.A, DNP
• Omer Farooq

• Clinical Social Worker in Odessa, TX
• Providers in Odessa, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.