Active NPI
Amy J. Stark, LCSW
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1053972554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2019020274
- Practice address
- 12141 Ladue Rd.
Saint Louis, MO 63141-8120 - Phone
- (314) 336-1011
- Fax
- (314) 878-4524
- NPI assigned
- Jun 25, 2019
- Last updated
- Jun 25, 2019
- 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 | 2019020274 | MO | Primary |
Addresses
Primary practice location
12141 Ladue Rd.
Saint Louis, MO 63141-8120
Mailing address
12141 Ladue Rd
Saint Louis, MO 63141-8120
Phone (314) 336-1011
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 |
|---|---|---|---|
| 2019020274 | MO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amy J. Stark, LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Olivette, MO
- NPI 1346927308
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561420800000",
"number": "1053972554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12141 LADUE RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418120",
"telephone_number": "314-336-1011",
"fax_number": "314-878-4524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12141 LADUE RD.",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418120",
"telephone_number": "314-336-1011",
"fax_number": "314-878-4524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "AMY",
"middle_name": "J.",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-25",
"last_updated": "2019-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2019020274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.