Active NPI
Amanda Wallace-Finocchio, LCSW
- Clinical Social Worker
- Stamford, CT
National Provider Identifier
1497427454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11750
- Practice address
- 104 North St
Stamford, CT 06902-2429 - Phone
- (203) 423-3012
- NPI assigned
- Sep 29, 2021
- Last updated
- Dec 9, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 108465 | NY | |
| Clinical Social Worker | 1041C0700X | 11750 | CT | Primary |
Addresses
Primary practice location
104 North St
Stamford, CT 06902-2429
Mailing address
104 North St Apt 803
Stamford, CT 06902-2429
Other names 1
- Amanda Marion Wallace
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | contact@amandawallaclcsw.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 31, 2025 through Jul 31, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108465 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670544000000",
"number": "1497427454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 NORTH ST APT 803",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069022429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 NORTH ST",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069022429",
"telephone_number": "203-423-3012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE-FINOCCHIO",
"first_name": "AMANDA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-29",
"last_updated": "2022-12-09",
"certification_date": "2022-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "108465",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "11750",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "contact@amandawallaclcsw.com",
"affiliation": "N",
"endpointDescription": "Encrypted business email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Encrypted business email",
"address_1": "104 North St",
"city": "Stamford",
"state": "CT",
"country_code": "US",
"postal_code": "069022429",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "WALLACE",
"middle_name": "MARION",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.