Amanda Martin

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111168 Issued in CA

Practice address

762 Cypress St
San Dimas, CA 91773

Phone

(909) 599-1227

NPI assigned

Oct 19, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846
  Medicare reassignment NPD
• Bountiful Family Services Inc

  • Community/Behavioral Health Agency
  • Henderson, NV
  • NPI 1093085425
  NPD (past)

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

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1235500091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 CYPRESS ST # 107",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733505",
            "telephone_number": "909-599-1227",
            "fax_number": "702-944-7846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 CYPRESS ST",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "91773",
            "telephone_number": "909-599-1227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1485 W Warm Springs Rd",
            "address_2": "# 107",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890147631",
            "country_code": "US",
            "telephone_number": "702-547-0201",
            "fax_number": "702-944-7846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-19",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "89378",
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "111168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chantal Markarian, MD
• Madison Kaley Markstrom, MSOT, OTR/L
• Juan Carlos Marquez
• Miguel Marquez
• Savana Kate Marroquin
• Jacqueline Martin
• Maria R. Martin, PH.D
• Ashley Nicole Martinez
• Faith Martinez
• Jennifer Marie Martinez

• Clinical Social Worker in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.