Amanda Lee Carrillo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW82461 Issued in CA

Practice address

3621 W Ash Ave
Fullerton, CA 92833-3107

Phone

(714) 872-0034

Fax

(213) 935-8728

NPI assigned

Sep 19, 2012

Sex

Female

Sole proprietor

Yes

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 CA

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

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.

• Mental Health and Nursing PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Anaheim, CA
  • NPI 1528693579
  Medicare reassignment NPD
• RCMH, Nursing Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Cypress, CA
  • NPI 1043187776
  Medicare reassignment NPD
• Renewed Community Mental Health

  • Psychiatry Physician
  • Anaheim, CA
  • NPI 1912736026

  Mental Health

  NPD
• Lamp Inc

  • Case Management Agency
  • Los Angeles, CA
  • NPI 1043344054
  NPD (past)

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574985600000",
    "number": "1477804227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 W ASH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928333107",
            "telephone_number": "714-872-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 W ASH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928333107",
            "telephone_number": "714-872-0034",
            "fax_number": "213-935-8728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2019-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW36736",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW82461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Carreno
• Andrea Alexia Carrera
• Esther Carrera, LMFT
• Grecia Mikela Carrera
• Mark Vincent Corpuz Carrera
• Carrie M Carrillo, PA
• Daisy Carrillo
• Daniela Carrillo
• Janet Carrillo
• Jennifer Ann Carroll, LMFT

• Clinical Social Worker in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2019; 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.

Verify at the official NPI Registry.