Active NPI
Amanda Jay Petry, LCSW
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1427558337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8638-C
- Practice address
- 1180 N Town Center Dr Ste 100
Las Vegas, NV 89144-6308 - Phone
- (775) 657-1688
- NPI assigned
- Feb 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 8638-C | NV | Primary |
Addresses
Primary practice location
1180 N Town Center Dr Ste 100
Las Vegas, NV 89144-6308
Mailing address
1180 N Town Center Dr Ste 100
Las Vegas, NV 89144-6308
Phone (775) 657-1688
Other practice location 1
911 N Buffalo Dr Unit 213
Las Vegas, NV 89128-0381
Phone (702) 405-8088
Other practice location 2
7390 W Sahara Ave Ste 240
Las Vegas, NV 89117-2764
Phone (702) 305-0234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100557642 | Medicaid | NV |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8638-C | NV | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659052800000",
"number": "1427558337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 N TOWN CENTER DR STE 100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891446308",
"telephone_number": "775-657-1688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1180 N TOWN CENTER DR STE 100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891446308",
"telephone_number": "775-657-1688"
}
],
"practiceLocations": [
{
"address_1": "911 N Buffalo Dr Unit 213",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891280381",
"country_code": "US",
"telephone_number": "702-405-8088",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7390 W Sahara Ave Ste 240",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891172764",
"country_code": "US",
"telephone_number": "702-305-0234",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETRY",
"first_name": "AMANDA",
"middle_name": "JAY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-16",
"last_updated": "2022-07-29",
"certification_date": "2022-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "8638-C",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100557642",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.