Individual provider Active NPI

Stephanie Ann McMackin, MSW, LCSW

  • Clinical Social Worker
  • Cheyenne, WY
National Provider Identifier
1073919684
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
730 Issued in WY
Practice address
2617 E Lincolnway Ste G
Cheyenne, WY 82001-5671
Phone
(307) 514-1288
Fax
(307) 514-0979
NPI assigned
Nov 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Clinical Social Worker 1041C0700X 730 WY Primary

Addresses

Primary practice location

2617 E Lincolnway Ste G
Cheyenne, WY 82001-5671

Mailing address

2617 E Lincolnway Ste G
Cheyenne, WY 82001-5671
Phone (307) 514-1288

Other practice location 1

821 W Pershing Blvd
Cheyenne, WY 82001-2537
Phone (307) 638-4625

Other practice location 2

3618 Rock Springs St
Cheyenne, WY 82001-1829
Phone (307) 631-6791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200228000902 WY Practitioner - Clinical Social Worker 5294162491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hope LLCGroup PAC ID 3476980673, 2 clinicians

Practice addresses (Care Compare)

2617 E Lincolnway
Suite G
Cheyenne, WY 82001-5671
Phone (307) 514-1288

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
730WYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hope, LLC Clinical CurrentSince Nov 30, 2019 Accepting new patients

Locations

2909 Bent Ave
Cheyenne, WY 82001
Phone (307) 634-6594

1920 Thomes Ave
Ste 110
Cheyenne, WY 82001
Phone (210) 823-3808

2617 E Lincolnway
Ste G
Cheyenne, WY 82001
Phone (307) 286-0921

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.

NPI Registry JSON

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1073919684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2617 E LINCOLNWAY STE G",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820015671",
            "telephone_number": "307-514-1288",
            "fax_number": "307-514-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2617 E LINCOLNWAY STE G",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820015671",
            "telephone_number": "307-514-1288",
            "fax_number": "307-514-0979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 W Pershing Blvd",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820012537",
            "country_code": "US",
            "telephone_number": "307-638-4625",
            "fax_number": "307-635-3965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3618 Rock Springs St",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820011829",
            "country_code": "US",
            "telephone_number": "307-631-6791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCMACKIN",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WY",
            "license": "730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.