Active NPI
Amy Ruth Crevola, LCSW
- Clinical Social Worker
- Corvallis, OR
National Provider Identifier
1689004335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L8049
- Practice address
- 969 NW Sycamore Ave
Corvallis, OR 97330-1530 - Phone
- (541) 714-3640
- Fax
- (541) 981-5069
- NPI assigned
- Nov 16, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L8049 | OR | Primary |
Addresses
Primary practice location
969 NW Sycamore Ave
Corvallis, OR 97330-1530
Mailing address
969 NW Sycamore Ave
Corvallis, OR 97330-1530
Phone (541) 714-3640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 2, 2019 through May 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L8049 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1689004335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "969 NW SYCAMORE AVE",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973301530",
"telephone_number": "541-714-3640",
"fax_number": "541-981-5069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "969 NW SYCAMORE AVE",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973301530",
"telephone_number": "541-714-3640",
"fax_number": "541-981-5069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CREVOLA",
"first_name": "AMY",
"middle_name": "RUTH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-16",
"last_updated": "2024-10-10",
"certification_date": "2024-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L8049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.