Individual provider Active NPI

Marlene Janice Anceno, LCSW

  • Clinical Social Worker
  • Rialto, CA
National Provider Identifier
1699228205
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW102051 Issued in CA
Practice address
850 E Foothill Blvd
Rialto, CA 92376-5230
Phone
(909) 421-9301
Fax
(909) 421-9219
NPI assigned
Jul 31, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW102051 CA Primary

Addresses

Primary practice location

850 E Foothill Blvd
Rialto, CA 92376-5230

Mailing address

850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (909) 421-9301

Other practice location 1

1255 W Colton Ave # 585
Redlands, CA 92374-2861
Phone (909) 747-4344

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

LicenseStateTypeSpecialty
LCSW102051CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1469923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1699228205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-421-9301",
            "fax_number": "909-421-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-421-9301",
            "fax_number": "909-421-9219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1255 W Colton Ave # 585",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923742861",
            "country_code": "US",
            "telephone_number": "909-747-4344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANCENO",
        "first_name": "MARLENE",
        "middle_name": "JANICE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-31",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW102051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.