Jessica Tawanda Fauntleroy, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15292 Issued in MD

Practice address

1501 Division St
Baltimore, MD 21217-3121

Phone

(410) 383-8300

NPI assigned

Sep 28, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506556800000",
    "number": "1255840609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 CRANSTON AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291908",
            "telephone_number": "443-282-8146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 DIVISION ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173121",
            "telephone_number": "410-383-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUNTLEROY",
        "first_name": "JESSICA",
        "middle_name": "TAWANDA",
        "name_prefix": "Ms.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2017-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "15292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Faulkner
• Kendall R Faulkner, M.D.
• Kiara Faulkner
• Daniell Fauntleroy
• Felicia C Fauntleroy, RN
• Mikayla Fauntleroy
• Steven Fauser, P.A.
• Christopher Faustin, MD
• Fausto Q. Aquino, Jr.,M.D.,P.a.
• Andrea Fava, M.D.

• Clinical Social Worker in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; 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.