Amanda Fackler, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LSW0000007118 Issued in TN

Practice address

2147 Maplewood Dr
Knoxville, TN 37920-2752

Phone

(270) 871-6976

NPI assigned

Jul 2, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1083097471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 MAPLEWOOD DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379202752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 MAPLEWOOD DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379202752",
            "telephone_number": "270-871-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKLER",
        "first_name": "AMANDA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "10478",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000007118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Tyler Ezell
• Robet Lee Ezzell
• Aaron Bruce Faacks, MD
• Mary Fabbrini, DO
• Grace Fabian, BSW
• Faculty Internal Medicine
• Faculty Internal Medicine PLLC
• Faculty Internal Medicine, PLLC
• Faculty Physicians Knoxville, PLLC
• Katie Fagan

• Clinical Social Worker in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.