Active NPI
Mackenzie A Amic, MSW, LSW
- Social Worker
- Canton, OH
National Provider Identifier
1073143020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S2004653
- Practice address
- 601 Cleveland Ave NW
Canton, OH 44702-1836 - Phone
- (330) 455-0374
- Fax
- (330) 453-6716
- NPI assigned
- Jan 17, 2020
- Last updated
- Aug 31, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S2004653 | OH | Primary |
Addresses
Primary practice location
601 Cleveland Ave NW
Canton, OH 44702-1836
Mailing address
625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374
Other practice location 1
3158 West St
Weirton, WV 26062-4637
Phone (304) 797-7733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0387993 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Unknown |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S2004653 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598832000000",
"number": "1073143020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021805",
"telephone_number": "330-455-0374",
"fax_number": "330-453-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021836",
"telephone_number": "330-455-0374",
"fax_number": "330-453-6716"
}
],
"practiceLocations": [
{
"address_1": "3158 West St",
"address_purpose": "LOCATION",
"city": "Weirton",
"state": "WV",
"postal_code": "260624637",
"country_code": "US",
"telephone_number": "304-797-7733",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AMIC",
"first_name": "MACKENZIE",
"middle_name": "A",
"credential": "MSW, LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-17",
"last_updated": "2020-08-31",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S2004653",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0387993",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Unknown",
"affiliation": "N",
"address_1": "3158 West St",
"city": "Weirton",
"state": "WV",
"country_code": "US",
"postal_code": "260624637",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Canton, OH
- Ambulance Associates of Canton, Inc.
- Raven Elizabeth Amburgey, CT
- America's Best Contacts & Eyeglasses
- American Current Care of Ohio PA Co
- American National Red Cross (American Red Cross Stark County Chapter)
- Neel Jignesh Amin
- Aminahs Home & Living LLC
- Brian Lamar Amison, DDS
- Laura Amison, PT
- Lindsey Ammond
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.