Mandy Fernandez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8861300 Issued in ID

Practice address

1777 E Clark St Ste 330
Pocatello, ID 83201-3357

Phone

(208) 478-9081

NPI assigned

Nov 16, 2020

Sex

Female

Sole proprietor

No

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.

• High Country Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Idaho Falls, ID
  • NPI 1295379865

  ID

  Medicare reassignment Care Compare group NPD
• High Country Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Afton, WY
  • NPI 1457472748

  WY

  Medicare reassignment Care Compare group NPD
• High Country Behavioral Health

  • Mental Illness Community Based Residential Treatment Facility
  • Douglas, WY
  • NPI 1750113882
  NPD
• High Country Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kemmerer, WY
  • NPI 1972624062
  NPD

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

High Country Behavioral Health 44 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in ID, WY2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 12, 2024.

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1407459258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 CHARLES PL",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013248",
            "telephone_number": "208-252-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 E CLARK ST STE 330",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013357",
            "telephone_number": "208-478-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MANDY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-16",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-39280",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "8861300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fernandezmandy04@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1777 E Clark St Ste 330",
            "city": "Pocatello",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832013357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Douglas Favor, MD
• Fellows Family Dental - Ad LLC
• Richard E. Fellows, D.D.S.
• John Abraham Fenstermaker, D.O.
• Luis Fernandez, MD
• Jordan Michael Ferro, PHARMD
• Ila Marie Fica, LPC, NCC
• Denise Ficken
• Kaitlin Findlay, FDN-P
• Barry D Finlay, BC HIS ACA

• All providers in Pocatello, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.