Individual provider Active NPI

Carrie Grange Isaacson, LCSW

  • Clinical Social Worker
  • Truckee, CA
National Provider Identifier
1679718647
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
23716 Issued in CA
Practice address
10201 Surrey PL
Truckee, CA 96161-1254
Phone
(510) 343-9832
NPI assigned
Dec 4, 2008
Last updated
Dec 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 073690 NY
Clinical Social Worker 1041C0700X 23716 CA Primary

Addresses

Primary practice location

10201 Surrey PL
Truckee, CA 96161-1254

Mailing address

11260 Donner Pass Rd Ste C1
Truckee, CA 96161-4845
Phone (917) 771-7114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Nov 14, 2023 through Nov 14, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
073690NYMDClinical Social Worker
23716CAMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Belonging Partnership Inc Clinical CurrentSince Dec 5, 2021 Accepting new patients

Locations

2443 Fillmore St
San Francisco, CA 94115
Phone (415) 689-8591

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1679718647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11260 DONNER PASS RD STE C1",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614845",
            "telephone_number": "917-771-7114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SURREY PL",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961611254",
            "telephone_number": "510-343-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANGE ISAACSON",
        "first_name": "CARRIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-04",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "073690",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "23716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.