Individual provider Active NPI

Tammy Andrade-de la Isla

  • Social Worker
  • Fresno, CA
National Provider Identifier
1255937892
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
LCSW119397 Issued in CA
Practice address
2560 W Shaw LN Ste 104
Fresno, CA 93711-2777
Phone
(559) 443-4800
NPI assigned
Dec 9, 2020
Last updated
Dec 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW91940 CA
Social Worker 104100000X ASW91940 CA
Social Worker 104100000X LCSW119397 CA Primary

Addresses

Primary practice location

2560 W Shaw LN Ste 104
Fresno, CA 93711-2777

Mailing address

2560 W Shaw LN Ste 104
Fresno, CA 93711-2777
Phone (559) 443-4800

Other practice location 1

4939 E Yale Ave
Fresno, CA 93727-1523
Phone (559) 443-4800

Other practice location 2

2020 High St Ste E
Selma, CA 93662-3518
Phone (559) 443-4800

Other names 1

  • Tammy Andrade Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20240516003492 CA Practitioner - Clinical Social Worker 0143661470 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW91940CAMDSocial Worker
LCSW119397CAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Mental Health CurrentSince Apr 16, 2024 Accepting new patients
Fresno County Superintendent of Schools CurrentSince Apr 1, 2024 Accepting new patients
Fresno County Superintendent of Schools CurrentSince Dec 17, 2023 Accepting new patients
Fresno County Superintendent of Schools PastSince May 17, 2020 Accepting new patients

Locations

2440 Tulare St
Ste 200
Fresno, CA 93721
Phone (559) 265-3089

2560 W Shaw Ln
Ste 104
Fresno, CA 93711
Phone (559) 431-1086

4939 E Yale Ave
Fresno, CA 93727
Phone (559) 443-4820

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

2020 High St
Ste E
Selma, CA 93662
Phone (559) 443-8000

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1255937892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 W SHAW LN STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112777",
            "telephone_number": "559-443-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 W SHAW LN STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937112777",
            "telephone_number": "559-443-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4939 E Yale Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937271523",
            "country_code": "US",
            "telephone_number": "559-443-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2020 High St Ste E",
            "address_purpose": "LOCATION",
            "city": "Selma",
            "state": "CA",
            "postal_code": "936623518",
            "country_code": "US",
            "telephone_number": "559-443-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDRADE-DE LA ISLA",
        "first_name": "TAMMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2023-12-11",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW91940",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW91940",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCSW119397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMMY",
            "last_name": "ANDRADE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.