Active NPI
Angela M Ellis-Lively
- Social Worker
- Beckley, WV
National Provider Identifier
1477276897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- BP00944946
- Practice address
- 28 Mallard CT
Beckley, WV 25801-3664 - Phone
- (304) 252-8409
- NPI assigned
- Sep 21, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | BP00944946 | WV | Primary |
Addresses
Primary practice location
28 Mallard CT
Beckley, WV 25801-3664
Mailing address
101 Bill Baker Way
Beckley, WV 25801-1505
Phone (304) 252-8324
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP00944946 | WV | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1477276897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BILL BAKER WAY",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258011505",
"telephone_number": "304-252-8324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 MALLARD CT",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258013664",
"telephone_number": "304-252-8409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS-LIVELY",
"first_name": "ANGELA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-21",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WV",
"license": "BP00944946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beckley, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.