Amy Elizabeth Prudencio, LCSW

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

License

149014863 Issued in IL

Practice address

1301 E. Walnut Street
Carbondale, IL 62901

Phone

(618) 457-3371

Fax

(618) 549-1608

NPI assigned

Sep 21, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shawnee Health Service and Development Corp

  dba Shawnee Health Pharmacy Carbondale

  • Community/Retail Pharmacy
  • Carbondale, IL
  • NPI 1760253447
  NPD (past)

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295244242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 E WALNUT ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015004",
            "telephone_number": "618-457-3371",
            "fax_number": "618-549-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E. WALNUT STREET",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-457-3371",
            "fax_number": "618-549-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDENCIO",
        "first_name": "AMY",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IL",
            "license": "149014863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pregnancy Matters
• Hunter Blaine Price, PHARMD
• Logan Price, PA-C
• Dana Lynn Pritchett, PTA
• Prorehab PC (Athletico Physical Therapy)
• Psychological Services and Chronic Pain Management Inc. (Psychological Services Inc.)
• Shawn Wayne Pyle, CRNA
• Debra Renee Queen, R.D.
• Gloria Queriapa-Valdes, BAS, CD (DONA)
• Radiologic Interpretations of Southern Illinois LTD

• School Social Worker in Carbondale, IL
• Providers in Carbondale, IL by specialty
• School Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.