Conrad Fountaine, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC00746700 Issued in NJ

Practice address

1930 Marlton Pike E Ste R91
Cherry Hill, NJ 08003-4207

Phone

(856) 816-7114

Fax

(856) 751-0505

NPI assigned

Jul 2, 2015

Sex

Male

Sole proprietor

No

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 NJ

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

Specialty

Clinical Social Worker

Education

Other, 1978

Medicare assignment

May accept Medicare assignment

Group practices

Meridian Counseling Services, LLCGroup PAC ID 3173835097, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Meridian Counseling Services, LLC

  • Clinical Social Worker
  • Cherry Hill, NJ
  • NPI 1962550210
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1316320807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E STE R91",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080034207",
            "telephone_number": "856-816-7114",
            "fax_number": "856-751-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E STE R91",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080034207",
            "telephone_number": "856-816-7114",
            "fax_number": "856-751-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAINE",
        "first_name": "CONRAD",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC00746700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise M Forys-Wiech, OTR
• Danielle Fostek
• Elizabeth Foster, PH.D.
• Megan Foster, DPT
• Megan K Foti, OT
• Noel Fournarakis, LAC
• Catherine Joyce Fowler
• Kevin A Fowler, BA
• Fox Rehab Indiana LLC
• Fox Rehabilitation Kids, LLC

• Clinical Social Worker in Cherry Hill, NJ
• Providers in Cherry Hill, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.