Active NPI
Rudolofo Menchaca, LMSW
- Clinical Social Worker
- Port Huron, MI
National Provider Identifier
1588819742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801088438
- Practice address
- 1209 Richardson St
Port Huron, MI 48060-3548 - Phone
- (810) 984-5156
- Fax
- (810) 984-5228
- NPI assigned
- Dec 1, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801088438 | MI | Primary |
Addresses
Primary practice location
1209 Richardson St
Port Huron, MI 48060-3548
Mailing address
1209 Richardson St
Port Huron, MI 48060-3548
Phone (810) 984-5156
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801088438 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1588819742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 RICHARDSON ST",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603548",
"telephone_number": "810-984-5156",
"fax_number": "810-984-5228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 RICHARDSON ST",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603548",
"telephone_number": "810-984-5156",
"fax_number": "810-984-5228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENCHACA",
"first_name": "RUDOLOFO",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-01",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801088438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
- Medexpress Urgent Care, PC - Michigan (MedExpress Urgent Care - Port Huron, Pine Grove Ave)
- Medical Staffing and Consulting Network,LLC
- Mark Stephen Meier
- Sally Leach Meier, LPC
- Meliora Therapy Center
- Mendelson Orthopedics PC
- Mendelson Orthopedics PC
- Mendelson Warren Pharmacy
- Deann Margaret Mercurio
- Mercy Amicare Home Healthcare, Port Huron (St. Joseph Mercy Home Care, Port Huron)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.