CAMILLE J FAGENSON L.C.S.W. NPI 1689702466

Social Worker (Clinical) in San Marino, CA

NPI 1689702466 Individual Female Social Worker Clinical PECOS Enrolled Opted-Out Medicare

About CAMILLE FAGENSON

Camille Fagenson is a provider established in San Marino, California and her medical specialization is social worker (clinical) . The NPI number of Camille Fagenson is 1689702466 and was assigned on March 2007. The practitioner's primary taxonomy code is 1041C0700X with license number LCS14489 (CA). The provider is registered as an individual and her NPI record was last updated 14 years ago.

A clinical social worker like Camille J Fagenson L.c.s.w. is licensed to diagnose and treat mental, behavioral, and emotional disorders. A clinical social worker helps patients develop strategies to change behavior or cope with difficult situations and refer patients to other resources or services, such as support groups or other mental health professionals.

Camille Fagenson is enrolled in PECOS and is eligible to order or refer healthcare services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).

Camille Fagenson is a non-participating provider of Medicare. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.

The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Camille Fagenson opted out of Medicare effective on 07-01-2013 until 07-01-2023. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.

NPI

1689702466

Provider Name CAMILLE J FAGENSON L.C.S.W.
Provider Location Address2400 MISSION ST SAN MARINO, CA 91108
Provider Mailing Address2400 MISSION ST SAN MARINO, CA 91108
GenderFemale
NPI Entity TypeIndividual
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date03-01-2007
Last Update Date11-26-2007


Primary Taxonomy

Taxonomy Code1041C0700X
ClassificationSocial Worker
TypeBehavioral Health & Social Service Providers
SpecializationClinical
License No.LCS14489
License StateCA
Taxonomy DescriptionA social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Business Address

CAMILLE J FAGENSON L.C.S.W.
2400 MISSION ST
SAN MARINO, CA
ZIP 91108
Phone: (626) 403-8999
Fax: (626) 403-8989

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Mailing Address

CAMILLE J FAGENSON L.C.S.W.
2400 MISSION ST
SAN MARINO, CA
ZIP 91108
Phone: (626) 403-8999
Fax: (626) 403-8989



Medicare Participation

What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.

Registered in PECOS? Yes
Opted-Out of MedicareYes
Opt-Out Effective Date07-01-2013
Opt-Out End Date07-01-2023
Eligible to Order and ReferYes
Eligible order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)No
Eligible order / refer Power Mobility DevicesNo

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
SW14489MEDICARE PIN (08)CA
R37655MEDICARE UPIN (02)CA

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1417999418DR. BERRY L. MCCORD M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1497833891DR. ROBERT TRUJILLO PH.D
Individual
Psychologist (Clinical)2400 MISSION ST 209
SAN MARINO, CA 91108
(626) 403-7400
1265507644DR. RYAN R COURDY M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1760510531DR. FRANK V MINERO M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1639207400 AURA-MARIE PAWLEY M.D.
Individual
Psychiatry & Neurology (Neurology)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1013045897 KAREN O GATES L.C.S.W.
Individual
Social Worker (Clinical)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1871621672 KAREN I MINERO L.C.S.W.
Individual
Social Worker (Clinical)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1114055183MS. LINDA M HILL MFT
Individual
Marriage & Family Therapist2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1053449934DR. TERRY ANN BISSELL M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1841328705DR. TIMOTHY J PYLKO M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1730218264 DANIEL F DOYLE M.F.T.
Individual
Marriage & Family Therapist2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1073642500 MARY JOY WON L.C.S.W.
Individual
Social Worker (Clinical)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1689704561MRS. MEGAN SNYDER-GROSSMAN M.F.T.
Individual
Marriage & Family Therapist2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1932359445DR. WARREN RITCHIE CHRISTIANSON II D.O.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1174777908 SUSAN BREDHOFF
Individual
Marriage & Family Therapist2400 MISSION ST #105
SAN MARINO, CA 91108
(626) 792-9121
1831110071 DORA L WANG MD
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1821004458 CAROL ANNE MCCORMICK NP
Individual
Nurse Practitioner (Psychiatric/Mental Health)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8989
1164811691SAN MARINO PSYCHIATRIC HOSPITALISTS, INC
Organization
Psychiatric Hospital2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1811025679DR. DANIEL THOMAS SUZUKI M.D.
Individual
Psychiatry & Neurology (Psychiatry)2400 MISSION ST
SAN MARINO, CA 91108
(626) 403-8999
1174987630BARBARA L. JANETZKE, PHD
Organization
Psychologist (Clinical)2400 MISSION ST
SAN MARINO, CA 91108
(626) 255-7512

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.