Active NPI
Allen R Stata, PHD, LCSW (PIP) ACSW
- Clinical Social Worker
- Marion, AL
National Provider Identifier
1861934705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2235C
- Practice address
- 104 Edwards Drive
Marion, AL 36756 - Phone
- (334) 815-2100
- Fax
- (334) 683-4114
- NPI assigned
- Nov 9, 2016
- Sex
- Male
- 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 | 2235C | AL | Primary |
Addresses
Primary practice location
104 Edwards Drive
Marion, AL 36756
Mailing address
1017 Medical Center Parkway
Selma, AL 36701
Phone (334) 875-2100
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2235C | AL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cahaba Center for Mental Health and Mental Retardation | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Selma, AL
- NPI 1134187727
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478649600000",
"number": "1861934705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 MEDICAL CENTER PARKWAY",
"city": "SELMA",
"state": "AL",
"postal_code": "36701",
"telephone_number": "334-875-2100",
"fax_number": "334-418-6540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 EDWARDS DRIVE",
"city": "MARION",
"state": "AL",
"postal_code": "36756",
"telephone_number": "334-815-2100",
"fax_number": "334-683-4114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATA",
"first_name": "ALLEN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PHD, LCSW (PIP) ACSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-09",
"last_updated": "2016-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AL",
"license": "2235C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.