Active NPI
Delise N Fair
- Social Worker
- Berkeley, CA
National Provider Identifier
1184327587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MSW011146
- Practice address
- 2150 Shattuck Ave
Berkeley, CA 94704-1345 - Phone
- (757) 768-0882
- NPI assigned
- Mar 24, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 15865 | SC | |
| Social Worker | 104100000X | MSW011146 | GA | Primary |
Addresses
Primary practice location
2150 Shattuck Ave
Berkeley, CA 94704-1345
Mailing address
PSC 473 Box 1155
Fpo, AP 96349-0012
Phone (407) 412-3933
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 |
|---|---|---|---|
| MSW011146 | GA | MD | Social Worker |
| 15865 | SC | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679616000000",
"number": "1184327587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "PSC 473 BOX 1155",
"city": "FPO",
"state": "AP",
"postal_code": "963490012",
"telephone_number": "407-412-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 SHATTUCK AVE",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041345",
"telephone_number": "757-768-0882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIR",
"first_name": "DELISE",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-24",
"last_updated": "2023-03-24",
"certification_date": "2023-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "15865",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "GA",
"license": "MSW011146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.