Theodore Faneuff, MSW,LISW-S, MBA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1440117.SUPV Issued in OH

Practice address

3335 Meijer Dr Ste 450
Toledo, OH 43617-3122

Phone

(419) 324-0334

NPI assigned

Aug 15, 2011

Last updated

Jul 26, 2016By the provider in NPPES

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

Other names 1

• Mr. Theodore Faneuff Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: theodorefaneuff@tdh.allscriptsdirect.net

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.

• Sylvania Therapy Services LLC

  • Clinical Social Worker
  • Toledo, OH
  • NPI 1932655495
  Authorized official Same address or phone
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

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

{
    "created_epoch": "1313366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1881973360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3335 MEIJER DR STE 450",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436173122",
            "telephone_number": "419-324-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3335 MEIJER DR STE 450",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436173122",
            "telephone_number": "419-324-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANEUFF",
        "first_name": "THEODORE",
        "name_prefix": "Mr.",
        "credential": "MSW,LISW-S, MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-15",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1100545",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1440117.SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THEODORE",
            "last_name": "FANEUFF",
            "prefix": "MR.",
            "credential": "MSW,LISW-S,MBA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Family Service of Northwest Ohio
• Family Service of NW Ohio
• Joanna Fan
• Zhaohui Fan, M.D.
• Kristen Therese Fandrey
• Lenae Fann, QMHS
• Annette Fannin
• Susan Fannin
• Kim Fant-Cousin
• Asha Faqi

• Clinical Social Worker in Toledo, OH
• Providers in Toledo, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; 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.

Verify at the official NPI Registry.