Shadaria Rene Prince, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW94800 Issued in CA

Practice address

2600 Ventura St Ste 110
Fresno, CA 93721-3041

Phone

(310) 654-9835

NPI assigned

Aug 27, 2014

Last updated

Jul 7, 2023By 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 3

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.

• Deeply Rooted Counseling & Wellness Center

  • Adolescent and Children Mental Health Clinic/Center
  • Fresno, CA
  • NPI 1871277764
  NPD Authorized official
• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1407448905
  NPD
• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Clovis, CA
  • NPI 1356933857
  NPD (past)
• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1831781343
  NPD (past)

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1669872578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4183 W WELDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937226893",
            "telephone_number": "310-654-9835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 VENTURA ST STE 110",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937213041",
            "telephone_number": "310-654-9835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1788 Celeste Ave",
            "address_purpose": "LOCATION",
            "city": "Clovis",
            "state": "CA",
            "postal_code": "936112069",
            "country_code": "US",
            "telephone_number": "559-243-7002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2291 N Hazel Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937225562",
            "country_code": "US",
            "telephone_number": "559-243-7002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3138 W Barstow Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937112603",
            "country_code": "US",
            "telephone_number": "559-243-7002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "SHADARIA",
        "middle_name": "RENE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-27",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW67543",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW94800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prime Orbbit LLC
• Primecare Equipment LLC
• Primer Paso Institute, Inc
• Karl Emerson Primero, M.D.
• Amy Prince, MA-CCC, SLP, BCBA
• Edward Principe
• Omari Jahi Pringle
• Miranda Diane Prints, MD
• Priority Care Medical LLC
• Priority Care Medical Transport LLC

• Clinical Social Worker in Fresno, CA
• Providers in Fresno, 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 7, 2023; 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.