NPIMap

Individual provider Active NPI

Amanda B Fetsko, MS, LCSW, CPRP

  • Clinical Social Worker
  • Chalreroi, PA
National Provider Identifier
1073641023
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW018512 Issued in PA
Practice address
250 Chamber Plaza
Chalreroi, PA 15022
Phone
(724) 489-0215
NPI assigned
Mar 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X SW130206 PA
Clinical Social Worker 1041C0700X CW018512 PA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X PA

Addresses

Primary practice location

250 Chamber Plaza
Chalreroi, PA 15022

Mailing address

250 Chamber Plaza
Charleroi, PA 15022-1605
Phone (724) 489-0215

Other identifiers 3

IdentifierTypeStateIssuer
1007288440027MedicaidPA
12482662OtherPACAQH
328834A336347OtherPAVALUE BEHAVIORAL HEALTH

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SW130206PAMDSocial Worker
CW018512PAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Behavioral Care, Inc. Past Accepting new patients
Centerville Clinics , Inc. Social Worker Past Accepting new patients
Centerville Clinics Inc. Past Accepting new patients
Centerville Clinics, Inc Blended Past Accepting new patients
Centerville Clinics, Inc. Past Accepting new patients
Centerville Clinics, Inc Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1073641023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CHAMBER PLAZA",
            "city": "CHARLEROI",
            "state": "PA",
            "postal_code": "150221605",
            "telephone_number": "724-489-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CHAMBER PLAZA",
            "city": "CHALREROI",
            "state": "PA",
            "postal_code": "15022",
            "telephone_number": "724-489-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETSKO",
        "first_name": "AMANDA",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "MS, LCSW, CPRP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW130206",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW018512",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440027",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12482662",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE BEHAVIORAL HEALTH",
            "identifier": "328834A336347",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.

Verify at the official NPI Registry.