Individual provider Active NPI

Amber Liponoga, LCSW

  • Clinical Social Worker
  • Columbia, MO
National Provider Identifier
1639763147
Registry record updated Apr 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2019027191 Issued in MO
Practice address
1500 Fellows PL Apt 3C
Columbia, MO 65201-8529
Phone
(573) 823-2842
NPI assigned
Feb 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2019027191 MO Primary

Addresses

Primary practice location

1500 Fellows PL Apt 3C
Columbia, MO 65201-8529

Mailing address

115 Conley Rd # 1032
Columbia, MO 65201-6465
Phone (573) 212-4456

Other identifiers 1

IdentifierTypeStateIssuer
490094703MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20221031002647 MO Practitioner - Clinical Social Worker 2365819547 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1511 Paris Rd
Columbia, MO 65201-5625
Phone (573) 212-4456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2019027191MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Eight Domains LLC Clinical CurrentSince Sep 1, 2025 Accepting new patients
Sondermind Provider Network LLC Clinical CurrentSince Oct 18, 2022 Accepting new patients

Locations

115 Conley Rd
Columbia, MO 65201
Phone (314) 327-2005

107 W 9th St
Fl 2
Kansas City, MO 64105
Phone (505) 382-2776

4625 Lindell Blvd
Ste 200300
Saint Louis, MO 63108
Phone (314) 396-7900

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743811200000",
    "number": "1639763147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 CONLEY RD # 1032",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016465",
            "telephone_number": "573-212-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FELLOWS PL APT 3C",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018529",
            "telephone_number": "573-823-2842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPONOGA",
        "first_name": "AMBER",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-24",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2019027191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490094703",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.