Destry P. Fallen, LISW-S

Primary specialty

Social WorkerTaxonomy code 104100000X

License

I.0005409-SUPV Issued in OH

Practice address

1 Childrens PLZ
Dayton, OH 45404-1898

Phone

(937) 641-5300

Fax

(937) 641-5134

NPI assigned

Jun 23, 2010

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1235440397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041898",
            "telephone_number": "937-641-5300",
            "fax_number": "937-641-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041898",
            "telephone_number": "937-641-5300",
            "fax_number": "937-641-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLEN",
        "first_name": "DESTRY",
        "middle_name": "P.",
        "name_prefix": "Mr.",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.0005409-SUPV",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0005409-SUPV",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Renee Fairres, BSN, RN, IBCLC
• Dan J Falke, L.I.C.D.C
• Valeriya Falkenshtern
• Jonna Falkner
• David J Fallang, M.D.
• Olivia Marie Falter
• Sharda Fambro
• Family First Vision Care Kentucky, LLC
• Family Matterz LTD.
• Family Orthodontics of Ohio Jim Shealy DDS LLC

• Social Worker in Dayton, OH
• Providers in Dayton, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.