Emory Madalyn Endicott, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2024037830 Issued in MO

Practice address

12141 Ladue Road
Saint Louis, MO 63141

Phone

(314) 898-0100

Fax

(314) 993-2828

NPI assigned

Jul 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Provident IncGroup PAC ID 0345217279, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Provident Inc.

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1710023791
  Medicare reassignment Care Compare group NPD
• Provident Inc

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1043491020
  NPD (past)

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1376276774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 OLIVE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031489",
            "telephone_number": "314-371-6500",
            "fax_number": "314-371-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12141 LADUE ROAD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-898-0100",
            "fax_number": "314-993-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDICOTT",
        "first_name": "EMORY",
        "middle_name": "MADALYN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-05",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2022020464",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2024037830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Encore Home Care Services II, LLC
• Encore Home Care Services LLC
• Endearment Home Health LLC
• Danielle Elizabeth Endejan, MA PLPC
• Lesley Maria Endermuhle, FNP
• Endless Care Home Health Services, Inc
• Endless Care Home Health Services, Inc
• Endocrinology Diabetes & Metabolism Consultants P C
• Erin Lynn Endres, CRNA
• Kristan Endris, MSW

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.