NPIMap

Individual provider Active NPI

Amy Elizabeth Brock, PSY S; NCSP

  • School Psychologist
  • Wise, VA
National Provider Identifier
1679098685
Registry record updated Jan 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
0813000402 Issued in VA
Practice address
PO Box 1217
Wise, VA 24293-1217
Phone
(276) 328-8017
Fax
(276) 328-8017
NPI assigned
Aug 10, 2017
Last updated
Jan 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 0813000402 VA Primary

Addresses

Primary practice location

PO Box 1217
Wise, VA 24293-1217

Mailing address

PO Box 1217
Wise, VA 24293-1217
Phone (276) 328-8017

Other practice location 1

PO Box 660
Wise, VA 24293-0660
Phone (276) 328-6113

Other practice location 2

30 Champions Ave
Big Stone Gap, VA 24219-1103
Phone (276) 523-0195

Other practice location 3

2 Champions Ave
Big Stone Gap, VA 24219-1103
Phone (276) 523-1290

Other practice location 4

2945 2nd Ave E
Big Stone Gap, VA 24219-3801
Phone (276) 523-4900

Other names 1

  • Amy Elizabeth Crawford Former name

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
0813000402VAMDSchool Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wise County Public Schools School Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1679098685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1217",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242931217",
            "telephone_number": "276-328-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1217",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242931217",
            "telephone_number": "276-328-8017",
            "fax_number": "276-328-8017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PO Box 660",
            "address_purpose": "LOCATION",
            "city": "Wise",
            "state": "VA",
            "postal_code": "242930660",
            "country_code": "US",
            "telephone_number": "276-328-6113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Champions Ave",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242191103",
            "country_code": "US",
            "telephone_number": "276-523-0195",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Champions Ave",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242191103",
            "country_code": "US",
            "telephone_number": "276-523-1290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2945 2nd Ave E",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242193801",
            "country_code": "US",
            "telephone_number": "276-523-4900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "AMY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PSY S; NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-10",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "VA",
            "license": "0813000402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "CRAWFORD",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wise, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.