Active NPI
Mary Rutledge Faucette, PHD
- Clinical Psychologist
- Moncks Corner, SC
National Provider Identifier
1245332329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 811
- Practice address
- 117 E Main St
Moncks Corner, SC 29461-3764 - Phone
- (843) 899-4949
- Fax
- (843) 899-7224
- NPI assigned
- Sep 1, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 811 | SC | Primary |
Addresses
Primary practice location
117 E Main St
Moncks Corner, SC 29461-3764
Mailing address
117 East Main Street
Moncks Corner, SC 29461-8354
Phone (843) 899-4949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSO353 | Medicaid | SC |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221004800000",
"number": "1245332329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 EAST MAIN STREET",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294618354",
"telephone_number": "843-899-4949",
"fax_number": "843-886-3350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 E MAIN ST",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294613764",
"telephone_number": "843-899-4949",
"fax_number": "843-899-7224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAUCETTE",
"first_name": "MARY",
"middle_name": "RUTLEDGE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2008-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "811",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSO353",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moncks Corner, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.