Active NPI
Amanda Patricia Mendizabal, LICSW
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1295047454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC50078216
- Practice address
- 1350 Connecticut Ave NW
Ste 309
Washington, DC 20036-1722 - Phone
- (202) 957-4465
- NPI assigned
- Jul 4, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50078216 | DC | Primary |
Addresses
Primary practice location
1350 Connecticut Ave NW
Ste 309
Washington, DC 20036-1722
Mailing address
1350 Connecticut Ave NW
Ste 309
Washington, DC 20036-1722
Phone (202) 957-4465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 10, 2023 through Jan 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50078216 | DC | MD | Clinical Social Worker |
| 20695 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278201600000",
"number": "1295047454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 CONNECTICUT AVE NW",
"address_2": "STE 309",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200361722",
"telephone_number": "202-957-4465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 CONNECTICUT AVE NW",
"address_2": "STE 309",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200361722",
"telephone_number": "202-957-4465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDIZABAL",
"first_name": "AMANDA",
"middle_name": "PATRICIA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-04",
"last_updated": "2010-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50078216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.