Individual provider Active NPI

Amanda Ruth McCutcheon

  • Social Worker
  • Southgate, MI
National Provider Identifier
1649568916
Registry record updated Jul 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6803085776 Issued in MI
Practice address
13101 Allen Rd
Southgate, MI 48195-2216
Phone
(734) 785-7700
NPI assigned
Jul 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6803085776 MI Primary

Addresses

Primary practice location

13101 Allen Rd
Southgate, MI 48195-2216

Mailing address

22742 Goddard Rd
Taylor, MI 48180-4126
Phone (313) 319-1259

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6803085776MIMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311120000000",
    "number": "1649568916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22742 GODDARD RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804126",
            "telephone_number": "313-319-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216",
            "telephone_number": "734-785-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCUTCHEON",
        "first_name": "AMANDA",
        "middle_name": "RUTH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6803085776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.