Sharon Koenig Fuller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW96024 Issued in CA

Practice address

64 Paseo Rosa
San Clemente, CA 92673-6506

Phone

(949) 842-4413

NPI assigned

Mar 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cognitive Care Solutions Group IncGroup PAC ID 5698066124, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cognitive Care Solutions Group Inc

  • Cognitive & Behavioral Psychologist
  • Santa Ana, CA
  • NPI 1548614183

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Cognitive Care Solutions Inc

  • Psychologist
  • Santa Ana, CA
  • NPI 1437583978

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1616284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616284800000",
    "number": "1962088906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 PASEO ROSA",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 PASEO ROSA",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736506",
            "telephone_number": "949-842-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "SHARON",
        "middle_name": "KOENIG",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-21",
        "last_updated": "2021-03-21",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW96024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mswfuller@gmail.com",
            "affiliation": "N",
            "address_1": "64 Paseo Rosa",
            "city": "San Clemente",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926736506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharon Josianne Friend, DMD
• Diana Liz Fruzza
• Qin Fu, L.A.C.
• Tiffany Fuentes
• Sachiko Virginia Fukuman, DDS
• Emma Furdui
• Reno Galassi, MA, LMFT
• Lauren Gallegos
• Maria Gallegos
• Hannah Kate Galsterer, DC

• Clinical Social Worker in San Clemente, CA
• Providers in San Clemente, 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 Mar 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.