Active NPI
Angela A Mouse, LICSW
- Clinical Social Worker
- Charleston, WV
National Provider Identifier
1639108558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- DP00080368
- Practice address
- 100 Peyton Way
Charleston, WV 25314 - Phone
- (304) 720-8466
- Fax
- (304) 720-8463
- NPI assigned
- Jul 2, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | DP00080368 | WV | Primary |
Addresses
Primary practice location
100 Peyton Way
Charleston, WV 25314
Mailing address
PO Box 7310
Charleston, WV 25356-0310
Phone (304) 776-7606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DP00080368 | Other | WV | WV SOCIAL WORK LICENSE |
Other names 1
- Angela S Amick
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 |
|---|---|---|---|
| DP00080368 | WV | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psimed Oasis, LLC | Clinical | Past | Accepting new patients |
| Center for Pain Relief, Inc. | Past | Accepting new patients | |
| Psimed, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Interventional Pain Medicine Physician
- Charleston, WV
- NPI 1831116375
-
- Psychiatry Physician
- Morgantown, WV
- NPI 1932444221
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639108558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7310",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253560310",
"telephone_number": "304-776-7606",
"fax_number": "304-776-7636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PEYTON WAY",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "25314",
"telephone_number": "304-720-8466",
"fax_number": "304-720-8463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSE",
"first_name": "ANGELA",
"middle_name": "A",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WV",
"license": "DP00080368",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV SOCIAL WORK LICENSE",
"identifier": "DP00080368",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ANGELA",
"last_name": "AMICK",
"middle_name": "S",
"credential": "MSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.