Active NPI
Amy Lynn Anderson, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1801079868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 66246
- Practice address
- 2525 Camino del Rio S Ste 315
San Diego, CA 92108-3784 - Phone
- (619) 708-0764
- NPI assigned
- Dec 13, 2007
- 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 | 66246 | CA | Primary |
Addresses
Primary practice location
2525 Camino del Rio S Ste 315
San Diego, CA 92108-3784
Mailing address
PO Box 1449
National City, CA 91951-1449
Phone (619) 597-1505
Other names 1
- Amy Lynn Mallit
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 4, 2023 through Apr 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66246 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591228800000",
"number": "1801079868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1449",
"city": "NATIONAL CITY",
"state": "CA",
"postal_code": "919511449",
"telephone_number": "619-597-1505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 CAMINO DEL RIO S STE 315",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083784",
"telephone_number": "619-708-0764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "AMY",
"middle_name": "LYNN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-13",
"last_updated": "2020-06-04",
"certification_date": "2020-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "66246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMY",
"last_name": "MALLIT",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.