Active NPI
Melinda Ruby Ancrum, LCSW
- Clinical Social Worker
- Rialto, CA
National Provider Identifier
1922140573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 27467
- Practice address
- 850 E Foothill Blvd
Rialto, CA 92376-5230 - Phone
- (909) 421-9495
- NPI assigned
- Feb 12, 2007
- Last updated
- Feb 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS 27467 | CA | Primary |
Addresses
Primary practice location
850 E Foothill Blvd
Rialto, CA 92376-5230
Mailing address
PO Box 10641
San Bernardino, CA 92423-0641
Phone (909) 496-5363
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 27467 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329782400000",
"number": "1922140573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10641",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924230641",
"telephone_number": "909-496-5363"
},
{
"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": "909-421-9495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANCRUM",
"first_name": "MELINDA",
"middle_name": "RUBY",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2012-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 27467",
"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 Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.