Amanda Marie Mack, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

126170 Issued in MA

Practice address

1400 VFW Pkwy
West Roxbury, MA 02132-4927

Phone

(617) 390-4585

Fax

(857) 203-6565

NPI assigned

Jan 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1912595752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 PLEASANT ST",
            "city": "BRIDGEWATER",
            "state": "MA",
            "postal_code": "023242351",
            "telephone_number": "781-812-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 VFW PKWY",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324927",
            "telephone_number": "617-390-4585",
            "fax_number": "857-203-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-07",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "224322",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "126170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julianna Maccarone
• Jennifer Lee Macdonald, MSRD
• Kelly Robin Macdonald, PHARMD.
• Patricia K Macdonald, RD LDN CDE
• Kelley Ann Macdougall
• Melissa Carolyn Mackinnon, R.N.
• Douglas J Maclaren, LIC. AC.
• Robert Clarke Macmaster, RRT
• James Alexander Macneill, CRNA
• Rebecca Joy Madjarov, PA

• Clinical Social Worker in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.