Amy J Song, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60422621 Issued in WA

Practice address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600

Phone

(702) 653-2965

NPI assigned

Jul 7, 2011

Last updated

Jul 21, 2022By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Healthcare Partners Medical Group (Coats) LTD.

  • Pediatrics Physician
  • Las Vegas, NV
  • NPI 1902883341
  NPD (past)
• Southern Nevada Psychological Services

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1467019125
  NPD (past)
• Wellspring Behavioral Health, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Eagle, ID
  • NPI 1124642293

  Clinical

  NPD (past)

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1134416324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916601",
            "telephone_number": "702-653-2965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "AMY",
        "middle_name": "J",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60422621",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60319179",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2044158",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lee Smith
• Lillian Paige Smith, DO
• Frederick Snyder, DPM
• Elizabeth M Sodomin, M.D.
• Soo A Sohn, RPH
• Jeffrey A Sorensen, MD
• Richard Daniel Soto, PH.D.
• Cameron Springer
• Amy Stacey, DO
• Nathan Stafford, PA-C

• Clinical Social Worker in Nellis AFB, NV
• Providers in Nellis AFB, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.