Amanda Lyne Clark, MSW, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21240 Issued in MD

Practice address

16701 Melford Blvd Ste 400
Bowie, MD 20715-4411

Phone

(415) 424-4266

Fax

(415) 520-6633

NPI assigned

May 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Lyne Jackson Former name

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Focus Point Solutions LLC

  • Adult Mental Health Clinic/Center
  • Princess Anne, MD
  • NPI 1285213454
  Medicare reassignment

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

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1144966714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 ESTERS BLVD STE 900",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750632233",
            "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": "16701 MELFORD BLVD STE 400",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154411",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMANDA",
        "middle_name": "LYNE",
        "credential": "MSW, LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-06",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "21240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JACKSON",
            "middle_name": "LYNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zoobee Chukwurah
• Alexander Chung, D.D.S.
• Meg Victoria Cisse
• Bryan Drogin Citrenbaum
• City Wide Treatment Center
• Britney Renee Clark
• Grace D. Clark, PH.D.
• Jeannine Avis Clark, MD
• Chester Chatterton Clarke, MD
• Osei Clarke, D.D.S

• Clinical Social Worker in Bowie, MD
• Providers in Bowie, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.