Active NPI
Amanda Moliterno
- Counselor
- Lawrenceville, GA
National Provider Identifier
1730896929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC012766
- Practice address
- 175 Gwinnett Dr
Lawrenceville, GA 30046-8444 - Phone
- (678) 209-2394
- NPI assigned
- Oct 28, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC012766 | GA | Primary |
Addresses
Primary practice location
175 Gwinnett Dr
Lawrenceville, GA 30046-8444
Mailing address
2403 Noble Creek Dr NW
Atlanta, GA 30327-5112
Phone (330) 398-4162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC012766 | GA | MD | Counselor |
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.
-
- Internal Medicine Physician
- Atlanta, GA
- NPI 1396798229
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666915200000",
"number": "1730896929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2403 NOBLE CREEK DR NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303275112",
"telephone_number": "330-398-4162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 GWINNETT DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468444",
"telephone_number": "678-209-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLITERNO",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-28",
"last_updated": "2022-10-28",
"certification_date": "2022-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "LPC012766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.