Active NPI
Amanda Marie Poncil, LMSW
- Social Worker
- Southfield, MI
National Provider Identifier
1417317470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801099161
- Practice address
- 17515 W 9 Mile Rd Ste 345
Southfield, MI 48075-4403 - Phone
- (734) 497-8986
- NPI assigned
- Mar 3, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| Social Worker | 104100000X | 6801099161 | MI | Primary |
Addresses
Primary practice location
17515 W 9 Mile Rd Ste 345
Southfield, MI 48075-4403
Mailing address
1 Ford PL Ste 3a
Detroit, MI 48202-3450
Other practice location 1
35425 W Michigan Ave
Wayne, MI 48184-9800
Phone (734) 467-7600
Other practice location 2
7737 Kercheval St Ste 217
Detroit, MI 48214-2437
Other names 1
- Amanda Marie Shelton
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
Interoperability endpoints
- aponcil844895@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1417317470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 FORD PL STE 3A",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17515 W 9 MILE RD STE 345",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754403",
"telephone_number": "734-497-8986"
}
],
"practiceLocations": [
{
"address_1": "35425 W Michigan Ave",
"address_purpose": "LOCATION",
"city": "Wayne",
"state": "MI",
"postal_code": "481849800",
"country_code": "US",
"telephone_number": "734-467-7600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7737 Kercheval St Ste 217",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482142437",
"country_code": "US",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PONCIL",
"first_name": "AMANDA",
"middle_name": "MARIE",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-03",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801099161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "SHELTON",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.