Active NPI
Amanda Lynn Cisse, MSW
- Clinical Social Worker
- Beaverton, MI
National Provider Identifier
1306186812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801091799
- Practice address
- 439 S Ross St
Beaverton, MI 48612-9101 - Phone
- (989) 422-5122
- NPI assigned
- Feb 20, 2013
- Last updated
- Mar 17, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 6801091799 | MI | Primary |
Addresses
Primary practice location
439 S Ross St
Beaverton, MI 48612-9101
Mailing address
9249 W Lake City Rd
Houghton Lake, MI 48629-9602
Phone (989) 422-5122
Other practice location 1
725 E State St
Sterling, MI 48659-9548
Phone (989) 654-2491
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1306186812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9249 W LAKE CITY RD",
"city": "HOUGHTON LAKE",
"state": "MI",
"postal_code": "486299602",
"telephone_number": "989-422-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "439 S ROSS ST",
"city": "BEAVERTON",
"state": "MI",
"postal_code": "486129101",
"telephone_number": "989-422-5122"
}
],
"practiceLocations": [
{
"address_1": "725 E State St",
"address_purpose": "LOCATION",
"city": "Sterling",
"state": "MI",
"postal_code": "486599548",
"country_code": "US",
"telephone_number": "989-654-2491",
"fax_number": "989-654-2348",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CISSE",
"first_name": "AMANDA",
"middle_name": "LYNN",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-20",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801091799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, MI
- Beaverton Family Pharmacy LLC (Beaverton Family Pharmacy)
- Beaverton Medical Center P.C.
- Cheryl Ann Biddinger, MS, LPC
- Douglas W Bouchey, RPH
- Richard A Call, PA-C
- Dr. Dale J Moser OD (Beaverton Family Eyecare)
- Adam Abrahm Engwis, LLMSW
- Family Health & Wellness P.C.
- Family Health & Wellness PC
- Cody Fryzel, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.