Individual provider Active NPI

Amy L. Pomaybo, LCSW

  • Clinical Social Worker
  • Butler, PA
National Provider Identifier
1154433696
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW015369 Issued in PA
Practice address
127 S McKean St
Butler, PA 16001-6029
Phone
(888) 924-3627
Fax
(724) 297-5670
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CW015369 PA Primary

Addresses

Primary practice location

127 S McKean St
Butler, PA 16001-6029

Mailing address

371 N Main St
Butler, PA 16001-4955
Phone (724) 498-7354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20061013000085 PA Practitioner - Clinical Social Worker 3072519198 Practice locations: Worthington, PA; Butler, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

127 S McKean St
Butler, PA 16001-6029
Phone (724) 498-7354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CW015369PAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Life LLC PastSince Feb 23, 2020 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1154433696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 N MAIN ST",
            "city": "BUTLER",
            "state": "PA",
            "postal_code": "160014955",
            "telephone_number": "724-498-7354",
            "fax_number": "724-297-5670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S MCKEAN ST",
            "city": "BUTLER",
            "state": "PA",
            "postal_code": "160016029",
            "telephone_number": "888-924-3627",
            "fax_number": "724-297-5670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMAYBO",
        "first_name": "AMY",
        "middle_name": "L.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW015369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Butler, PA

Sources for this page

Verify at the official NPI Registry.