Active NPI
Elaine Ruth Faucett
- Clinical Social Worker
- Concord, CA
National Provider Identifier
1366968836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 111997
- Practice address
- 2975 Treat Blvd Ste C5
Concord, CA 94518-3631 - Phone
- (925) 219-9009
- NPI assigned
- Aug 16, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Clinical Social Worker | 1041C0700X | 111997 | CA | Primary |
Addresses
Primary practice location
2975 Treat Blvd Ste C5
Concord, CA 94518-3631
Mailing address
165 Coleridege Dr
Vallejo, CA 94591
Phone (707) 324-4765
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111997 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1366968836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 COLERIDEGE DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "94591",
"telephone_number": "707-324-4765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2975 TREAT BLVD STE C5",
"city": "CONCORD",
"state": "CA",
"postal_code": "945183631",
"telephone_number": "925-219-9009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAUCETT",
"first_name": "ELAINE",
"middle_name": "RUTH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-16",
"last_updated": "2022-12-22",
"certification_date": "2022-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "111997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.