Active NPI
Amy Jennifer Phillips, LCSW
- Clinical Social Worker
- Truckee, CA
National Provider Identifier
1093411092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW20260
- Practice address
- 10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234 - Phone
- (415) 424-4266
- Fax
- (415) 520-6633
- NPI assigned
- Feb 1, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149023819 | IL | |
| School Social Worker | 1041S0200X | 1463192 | FL | |
| Clinical Social Worker | 1041C0700X | SW20260 | FL | Primary |
Addresses
Primary practice location
10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234
Mailing address
9100 S Dadeland Blvd Ste 1500
Miami, FL 33156-7816
Phone (415) 424-4266
Other practice location 1
301 4th St SW
Largo, FL 33770-3536
Phone (727) 588-6355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1409 | Other | FL | SCHOOL-BASED MEDICAID BILLING |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW20260 | FL | MD | Clinical Social Worker |
| 149023819 | IL | MD | Clinical Social Worker |
| 1463192 | FL | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1093411092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9100 S DADELAND BLVD STE 1500",
"city": "MIAMI",
"state": "FL",
"postal_code": "331567816",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10775 PIONEER TRL STE 215",
"city": "TRUCKEE",
"state": "CA",
"postal_code": "961610234",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
}
],
"practiceLocations": [
{
"address_1": "301 4th St SW",
"address_purpose": "LOCATION",
"city": "Largo",
"state": "FL",
"postal_code": "337703536",
"country_code": "US",
"telephone_number": "727-588-6355",
"fax_number": "727-588-6237",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "AMY",
"middle_name": "JENNIFER",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-01",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149023819",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "FL",
"license": "1463192",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW20260",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SCHOOL-BASED MEDICAID BILLING",
"identifier": "1409",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Truckee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.