Individual provider Active NPI

Amanda Owens, MSW

  • Clinical Social Worker
  • Worcester, MA
National Provider Identifier
1295222644
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
121188 Issued in MA
Practice address
4 Mann St
Worcester, MA 01602-3414
Phone
(508) 755-0333
NPI assigned
Apr 20, 2018
Last updated
Apr 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC20932 ME
Clinical Social Worker 1041C0700X 0904013872 VA
Clinical Social Worker 1041C0700X 121188 MA Primary

Addresses

Primary practice location

4 Mann St
Worcester, MA 01602-3414

Mailing address

51 Union St
Ste G02
Worcester, MA 01608-1138
Phone (508) 755-0333

Other names 1

  • Amanda Tetreault Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20180615001210 MA Practitioner - Clinical Social Worker 1456606482 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
121188MAMDClinical Social Worker
LC20932MEMDClinical Social Worker
0904013872VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Bridge of Central Massachusetts, Inc CurrentSince May 6, 2018 Accepting new patients
The Bridge of Central Massachusetts, Inc. Current Accepting new patients

Locations

4 Mann St
Worcester, MA 01602
Phone (508) 318-7350

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1295222644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 UNION ST",
            "address_2": "STE G02",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081138",
            "telephone_number": "508-755-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MANN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016023414",
            "telephone_number": "508-755-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWENS",
        "first_name": "AMANDA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-20",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC20932",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013872",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "TETREAULT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.