Amy Michelle Bichsel Pacheco Pina, LCSW
Individual provider Active NPI Clinical Social Worker · Southaven, MS
NPI 1679701205 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1679701205
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 126155 (MA)
- Practice address
- 2124 Kindlewood Dr
Southaven, MS 38672-8623 - Phone
- (402) 871-7735
- NPI assigned
- Jun 22, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in TX, TN, KS, MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250227000361 | TX | Practitioner - Clinical Social Worker | 2961922406 | Reassigns benefits to 1 organization |
| I20250227000806 | TN | Practitioner - Clinical Social Worker | 2961922406 | Reassigns benefits to 1 organization |
| I20250305004109 | KS | Practitioner - Clinical Social Worker | 2961922406 | Reassigns benefits to 1 organization |
| I20250328001905 | MA | Practitioner - Clinical Social Worker | 2961922406 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126155 | MA | MD | Clinical Social Worker |
| 10162 | MS | MD | Clinical Social Worker |
| 007174 | IA | MD | Chiropractor |
| 110948 | TX | MD | Occupational Therapist |
| 7961 | TN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCCD FL Psychiatry Services PA | Current |
Accepting new patients | |
| MCCD KS Psychiatry Services PA | Current |
Accepting new patients |
Locations
8101 College Blvd
Ste 100
Overland Park, KS 66210
Phone (913) 227-9605
265 Franklin St
Ste 1702
Boston, MA 02110
Phone (203) 721-6500
300 Baker Ave
Ste 300
Concord, MA 01742
Phone (864) 336-2731
315 Deaderick St
Ste 1550
Nashville, TN 37238
Phone (615) 554-3233
1400 N Coit Rd
Ste 302
McKinney, TX 75071
Phone (214) 504-3005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10162 | MS | |
| Clinical Social Worker | 1041C0700X | 7961 | TN | |
| Clinical Social Worker | 1041C0700X | 007174 | IA | |
| Clinical Social Worker | 1041C0700X | 126155 | MA | Yes |
Addresses
Primary practice location
2124 Kindlewood Dr
Southaven, MS 38672-8623
Mailing address
2124 Kindlewood Dr
Southaven, MS 38672-8623
Phone (402) 871-7735
Other providers in Southaven, MS
- Nicholas Thomas Betts
- Mohammed Bhaiyat
- Zainab-Tasneem Bhaiyat
- Sonal Bhakta
- Mikul Bhikha
- John Carl Biery Jr.
- Michael Bifano
- Michelle Lee Bishop
- Debashis Biswas
- Chastity Black
All providers in Southaven, MS · Clinical Social Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.