Individual provider Active NPI

Amy M Martin, LCSW

  • Clinical Social Worker
  • Glen Allen, VA
National Provider Identifier
1831230663
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904005963 Issued in VA
Practice address
10299 Woodman Rd
Glen Allen, VA 23060-4419
Phone
(804) 727-8500
Fax
(804) 727-8580
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904005963 VA Primary

Addresses

Primary practice location

10299 Woodman Rd
Glen Allen, VA 23060-4419

Mailing address

10299 Woodman Rd
Glen Allen, VA 23060-4419
Phone (804) 727-8500

Other identifiers 2

IdentifierTypeStateIssuer
179936OtherVAANTHEM
085319MOtherVASENTARA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050815000445 VA Practitioner - Clinical Social Worker 2567492135 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hanover Counseling Associates, PLLC Clinical CurrentSince Jun 19, 2018 Accepting new patients

Locations

8249 Crown Colony Pkwy
Ste 200
Mechanicsville, VA 23116
Phone (804) 789-1224

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358899200000",
    "number": "1831230663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10299 WOODMAN RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230604419",
            "telephone_number": "804-727-8500",
            "fax_number": "804-727-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10299 WOODMAN RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230604419",
            "telephone_number": "804-727-8500",
            "fax_number": "804-727-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "AMY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2013-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "179936",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA",
            "identifier": "085319M",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.