Active NPI
Colleen Clendaniel, LCSW
- Clinical Social Worker
- Mandeville, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 112477
- Practice address
- 372 Sandalwood Dr
Mandeville, LA 70448-6357 - Phone
- (703) 615-0418
- NPI assigned
- Aug 21, 2023
- Last updated
- Aug 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW138188 | PA | |
| Clinical Social Worker | 1041C0700X | 112477 | CA | Primary |
Addresses
Primary practice location
372 Sandalwood Dr
Mandeville, LA 70448-6357
Mailing address
372 Sandalwood Dr
Mandeville, LA 70448-6357
Phone (703) 615-0418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW138188 | PA | MD | Clinical Social Worker |
| 113046 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encora Health Inc | Current | Accepting new patients |
Locations
101 E Green St
Ste 11
Pasadena, CA 91105
Phone (626) 261-1727
20333 State Highway 249
Ste 430
Houston, TX 77070
Phone (866) 334-3006
2002 Timberloch Pl
Ste 200
The Woodlands, TX 77380
Phone (281) 815-0899
Organizations & group practices 2
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.
-
- Social Worker
- Rancho Cucamonga, CA
- NPI 1184455586
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692576000000",
"number": "1649054941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "372 SANDALWOOD DR",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704486357",
"telephone_number": "703-615-0418",
"fax_number": "703-615-0418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "372 SANDALWOOD DR",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704486357",
"telephone_number": "703-615-0418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLENDANIEL",
"first_name": "COLLEEN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-21",
"last_updated": "2023-08-21",
"certification_date": "2023-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "SW138188",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "112477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.