Individual provider Active NPI

Amanda Manske, LCSW, RPT

  • Clinical Social Worker
  • Lake City, FL
National Provider Identifier
1649985334
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW19170 Issued in FL
Practice address
826 SW Main Blvd Ste 102
Lake City, FL 32025-5742
Phone
(386) 984-5366
NPI assigned
Jan 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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 SW19170 FL Primary

Addresses

Primary practice location

826 SW Main Blvd Ste 102
Lake City, FL 32025-5742

Mailing address

826 SW Main Blvd Ste 102
Lake City, FL 32025-5742
Phone (386) 984-5366

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sacredwingscounseling@gamil.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20231108000036 FL Practitioner - Clinical Social Worker 3971959081 Reassigns benefits to 1 organization
Practice locations: Lake City, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince Apr 3, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

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": "1674000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1649985334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 SW MAIN BLVD STE 102",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255742",
            "telephone_number": "386-984-5366",
            "fax_number": "386-287-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 SW MAIN BLVD STE 102",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255742",
            "telephone_number": "386-984-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSKE",
        "first_name": "AMANDA",
        "credential": "LCSW, RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW19170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sacredwingscounseling@gamil.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "826 SW Main Blvd Ste 102",
            "city": "Lake City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320255742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.