Individual provider Active NPI

Amanda Elizabeth Henderson

  • Clinical Social Worker
  • Brighton, MI
National Provider Identifier
1295511020
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801096618 Issued in MI
Practice address
2200 Genoa Business Park Dr Ste 100
Brighton, MI 48114-5328
Phone
(517) 882-3732
NPI assigned
Sep 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Social Worker 1041S0200X 6801096618 MI
Clinical Social Worker 1041C0700X 6801096618 MI Primary

Addresses

Primary practice location

2200 Genoa Business Park Dr Ste 100
Brighton, MI 48114-5328

Mailing address

20500 Eureka Rd Ste 200
Taylor, MI 48180-6394

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20231006002244 MI Practitioner - Clinical Social Worker 1456706712 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

2200 Genoa Business Park Dr
Suite 100
Brighton, MI 48114-5328
Phone (810) 494-7180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801096618MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Downriver Mental Health Clinic PC Clinical CurrentSince Oct 4, 2023 Accepting new patients
Downriver Mental Health Clinic PC Clinical CurrentSince Oct 4, 2023 Accepting new patients

Locations

2200 Genoa Business Park Dr
Ste 100
Brighton, MI 48114
Phone (810) 449-7180

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

20500 Eureka Rd
Ste 200
Taylor, MI 48180
Phone (734) 285-8282

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1295511020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20500 EUREKA RD STE 200",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481806394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 GENOA BUSINESS PARK DR STE 100",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481145328",
            "telephone_number": "517-882-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MI",
            "license": "6801096618",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801096618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MI

Sources for this page

Verify at the official NPI Registry.