Individual provider Active NPI

Amanda Broad, MSW, LSW, ASW

  • Clinical Social Worker
  • Napa, CA
National Provider Identifier
1891164109
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ASW66526 Issued in CA
Practice address
3260 Beard Rd
Suite 4
Napa, CA 94558-3423
Phone
(707) 287-3416
NPI assigned
Sep 16, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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 ASW66526 CA Primary

Addresses

Primary practice location

3260 Beard Rd
Suite 4
Napa, CA 94558-3423

Mailing address

3260 Beard Rd
Suite 4
Napa, CA 94558-3423
Phone (707) 287-3416

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

State licenses

LicenseStateTypeSpecialty
ASW66526CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1891164109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3260 BEARD RD",
            "address_2": "SUITE 4",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945583423",
            "telephone_number": "707-287-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 BEARD RD",
            "address_2": "SUITE 4",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945583423",
            "telephone_number": "707-287-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROAD",
        "first_name": "AMANDA",
        "credential": "MSW, LSW, ASW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-16",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW66526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Napa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.