Stacie Lynn Fanelli, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

105876 Issued in CA

Practice address

9135 Archibald Ave Ste B
Rancho Cucamonga, CA 91730-5227

Phone

(626) 838-3406

NPI assigned

Oct 18, 2017

Last updated

Jul 2, 2024By the provider in NPPES

Sex

Female

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stacie Fanelli, Licensed Clinical Social Worker, Professional Corporation

  dba Autonomous Minds Therapy

  • Clinical Social Worker
  • Rancho Cucamonga, CA
  • NPI 1538952098
  NPD Authorized official

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1366953226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9135 ARCHIBALD AVE STE B",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305227",
            "telephone_number": "626-838-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 ARCHIBALD AVE STE B",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305227",
            "telephone_number": "626-838-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANELLI",
        "first_name": "STACIE",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW024176",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "105876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• John Fang, L.AC.
• Kevin Fang, DMD
• Stephanie Fang
• Jennifer Fannin
• Kimberly Fanning-Shiles, LMFT

• Clinical Social Worker in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.