Active NPI
Angela McMullin, LCSW
- Clinical Social Worker
- Glendale, AZ
National Provider Identifier
1053767558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-18593
- Practice address
- 18205 N 51St Ave Ste 109
Glendale, AZ 85308-1491 - Phone
- (480) 202-9545
- Fax
- (855) 595-2710
- NPI assigned
- May 13, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2016010634 | MO | |
| Clinical Social Worker | 1041C0700X | 2018043211 | MO | |
| Clinical Social Worker | 1041C0700X | LCSW-18593 | AZ | Primary |
Addresses
Primary practice location
18205 N 51St Ave Ste 109
Glendale, AZ 85308-1491
Mailing address
22312 E Boot Hill Pkwy
Fort McDowell, AZ 85264-4109
Phone (480) 202-9545
Other practice location 1
2875 Hwy MM
Gray Summit, MO 63039
Phone (636) 451-6066
Other practice location 2
22312 E. Boot Hill Parkway
Fort McDowell, AZ 85264
Phone (480) 202-9545
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 |
|---|---|---|---|
| 2016010634 | MO | MD | Clinical Social Worker |
| 2018043211 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1053767558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22312 E BOOT HILL PKWY",
"city": "FORT MCDOWELL",
"state": "AZ",
"postal_code": "852644109",
"telephone_number": "480-202-9545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18205 N 51ST AVE STE 109",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853081491",
"telephone_number": "480-202-9545",
"fax_number": "855-595-2710"
}
],
"practiceLocations": [
{
"address_1": "2875 Hwy MM",
"address_purpose": "LOCATION",
"city": "Gray Summit",
"state": "MO",
"postal_code": "63039",
"country_code": "US",
"telephone_number": "636-451-6066",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "22312 E. Boot Hill Parkway",
"address_purpose": "LOCATION",
"city": "Fort McDowell",
"state": "AZ",
"postal_code": "85264",
"country_code": "US",
"telephone_number": "480-202-9545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCMULLIN",
"first_name": "ANGELA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-13",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2016010634",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2018043211",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW-18593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.