Active NPI
Amanda Nicole Petrunak, LSW
- Social Worker
- Tarentum, PA
National Provider Identifier
1851675375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 702 2ND Ave
Tarentum, PA 15084-2004 - Phone
- (724) 230-3242
- Fax
- (724) 230-3270
- NPI assigned
- Oct 3, 2011
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
702 2ND Ave
Tarentum, PA 15084-2004
Mailing address
702 2ND Ave
Tarentum, PA 15084-2004
Phone (724) 230-3242
Other practice location 1
131 Market St
Johnstown, PA 15901-1628
Phone (814) 534-0745 ext. 351
Other names 1
- Ms. Amanda Nicole Ravida
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | CommunityLifeTarentum@upmcdirect.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617580800000",
"number": "1851675375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 2ND AVE",
"city": "TARENTUM",
"state": "PA",
"postal_code": "150842004",
"telephone_number": "724-230-3242",
"fax_number": "724-230-3270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 2ND AVE",
"city": "TARENTUM",
"state": "PA",
"postal_code": "150842004",
"telephone_number": "724-230-3242",
"fax_number": "724-230-3270"
}
],
"practiceLocations": [
{
"address_1": "131 Market St",
"address_purpose": "LOCATION",
"city": "Johnstown",
"state": "PA",
"postal_code": "159011628",
"country_code": "US",
"telephone_number": "814-534-0745 x351",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETRUNAK",
"first_name": "AMANDA",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-03",
"last_updated": "2021-04-05",
"certification_date": "2021-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "CommunityLifeTarentum@upmcdirect.com",
"affiliation": "N",
"endpointDescription": "Community LIFE Center Direct Address",
"address_1": "702 2nd Ave",
"city": "Tarentum",
"state": "PA",
"country_code": "US",
"postal_code": "150842004",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "RAVIDA",
"middle_name": "NICOLE",
"prefix": "MS.",
"credential": "MSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tarentum, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.