Active NPI
Sally W. Fine, LIMHP, MSW, MA
- Clinical Social Worker
- Omaha, NE
National Provider Identifier
1922167709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 79
- Practice address
- 11414 W Center Rd
Suite 220
Omaha, NE 68144-4487 - Phone
- (402) 330-4014
- Fax
- (402) 334-2930
- NPI assigned
- Dec 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 769 | NE | |
| Clinical Social Worker | 1041C0700X | 79 | NE | Primary |
Addresses
Primary practice location
11414 W Center Rd
Suite 220
Omaha, NE 68144-4487
Mailing address
2520 S 98TH Ave
Omaha, NE 68124-1910
Phone (402) 391-0589
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82383 | Other | NE | BLUE CROSS BLUE SHIELD |
| 238567 | Other | NE | MIDLANDS CHOICE |
| 47068631113 | Medicaid | NE |
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79 | NE | MD | Clinical Social Worker |
| 769 | NE | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids Inc. | Mental Health | 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 Counselor
- Omaha, NE
- NPI 1578648697
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1922167709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2520 S 98TH AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681241910",
"telephone_number": "402-391-0589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11414 W CENTER RD",
"address_2": "SUITE 220",
"city": "OMAHA",
"state": "NE",
"postal_code": "681444487",
"telephone_number": "402-330-4014",
"fax_number": "402-334-2930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FINE",
"first_name": "SALLY",
"middle_name": "W.",
"credential": "LIMHP, MSW, MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-07",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "769",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "79",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "82383",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "238567",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47068631113",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.