Aimee Benton Wickersham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-18914 Issued in AZ

Practice address

15593 W Mackenzie Dr
Goodyear, AZ 85395-7779

Phone

(321) 961-3393

NPI assigned

Oct 28, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Teris Health Services LLC

  • Professional Counselor
  • Phoenix, AZ
  • NPI 1215422126
  Medicare reassignment NPD
• Live Life Now Health Group PA

  • Addiction Medicine (Family Medicine) Physician
  • Yonkers, NY
  • NPI 1770111429

  AZ

  Medicare reassignment NPD
• Teri'S Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Phoenix, AZ
  • NPI 1790374833
  NPD

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1104426204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15593 W MACKENZIE DR",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853957779",
            "telephone_number": "321-961-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15593 W MACKENZIE DR",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853957779",
            "telephone_number": "321-961-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "AIMEE",
        "middle_name": "BENTON",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-18914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal N White, MHCA
• Jazz Taylor White, MOTR/L
• Samantha White
• Robert P Whitehead, MD
• Cheryl Lea Whiting
• Erich A Widemark, PHD, FNP-BC
• Michele Wiest-Alvarez
• Jonathan J Wiggenhorn, D.O.
• Wild West Orthodontics Inc.
• Wild West Orthodontics P.C

• Clinical Social Worker in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.