Active NPI
Amy Henderson, LCSW
- Clinical Social Worker
- Salt Lake City, UT
National Provider Identifier
1790239408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8911079-3501
- Practice address
- 65 S Mario Capecchi Dr
Salt Lake City, UT 84132-0005 - Phone
- (801) 585-0499
- Fax
- (801) 581-3357
- NPI assigned
- Aug 10, 2016
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8911079-3501 | UT | Primary |
Addresses
Primary practice location
65 S Mario Capecchi Dr
Salt Lake City, UT 84132-0005
Mailing address
65 S Mario Capecchi Dr
Salt Lake City, UT 84132-0005
Phone (801) 585-0499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2022 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8911079-3501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1790239408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 S MARIO CAPECCHI DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320005",
"telephone_number": "801-585-0499",
"fax_number": "801-581-3357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 S MARIO CAPECCHI DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320005",
"telephone_number": "801-585-0499",
"fax_number": "801-581-3357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "AMY",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-10",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "8911079-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.