Individual provider Active NPI

Amber Leigh Laurie

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1164083614
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
102739 Issued in CA
Practice address
3505 Camino del Rio S Ste 338
San Diego, CA 92108-4017
Phone
(619) 880-6427
NPI assigned
Jun 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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 102739 CA Primary

Addresses

Primary practice location

3505 Camino del Rio S Ste 338
San Diego, CA 92108-4017

Mailing address

734 10TH Ave
San Diego, CA 92101-6502
Phone (619) 239-4663

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

State licenses

LicenseStateTypeSpecialty
102739CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Living Within Therapy- Marriage and Family Therapy CurrentSince Feb 6, 2022 Accepting new patients
Community Research Foundation Inc Clinical Past Accepting new patients
Community Research Foundation Inc Past Accepting new patients

Locations

3505 Camino del Rio S
Ste 338
San Diego, CA 92108
Phone (619) 539-3775

Organizations & group practices 3

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": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1164083614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 10TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016502",
            "telephone_number": "619-239-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 CAMINO DEL RIO S STE 338",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084017",
            "telephone_number": "619-880-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAURIE",
        "first_name": "AMBER",
        "middle_name": "LEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "102739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.