Russell Reed

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

100786 Issued in CA

Practice address

4250 Fowler LN Ste 204
Diamond Springs, CA 95619-9782

Phone

(530) 626-3105

NPI assigned

Jun 19, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sierra Child and Family Services

  • Community/Behavioral Health Agency
  • Diamond Springs, CA
  • NPI 1144343609
  NPD (past)

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

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1881076396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956190699",
            "telephone_number": "530-957-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 FOWLER LN STE 204",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199782",
            "telephone_number": "530-626-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "RUSSELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-19",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "100786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Lorraine Prophet
• John Bruce Quantrille
• G Bruce Quinn, PH.D.
• Jazmin Ramirez
• Brandy Rebolledo
• Carlie Regan
• Elsa Renteria
• Guadalupe Rivas
• Nathan James Robinson, LVN
• Melinda Carol Rollo, LMFT

• Clinical Social Worker in Diamond Springs, CA
• Providers in Diamond Springs, 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 Jun 7, 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.