Active NPI
Achilles Dominic Angelicchio, LCSW
- Clinical Social Worker
- Fishers, IN
National Provider Identifier
1336718576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34009251A
- Practice address
- 11186 Avila Way
Fishers, IN 46038-4628 - Phone
- (317) 514-8462
- NPI assigned
- Jun 22, 2021
- Sex
- Male
- 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 | 34009251A | IN | Primary |
Addresses
Primary practice location
11186 Avila Way
Fishers, IN 46038-4628
Mailing address
11186 Avila Way
Fishers, IN 46038-4628
Phone (317) 514-8462
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34009251A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1336718576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11186 AVILA WAY",
"city": "FISHERS",
"state": "IN",
"postal_code": "460384628",
"telephone_number": "317-514-8462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11186 AVILA WAY",
"city": "FISHERS",
"state": "IN",
"postal_code": "460384628",
"telephone_number": "317-514-8462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANGELICCHIO",
"first_name": "ACHILLES",
"middle_name": "DOMINIC",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-22",
"last_updated": "2021-06-22",
"certification_date": "2021-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34009251A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.