Active NPI
Amy Marie Dibble
- Clinical Social Worker
- Prescott, AZ
National Provider Identifier
1942089693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-21373
- Practice address
- 642 Dameron Dr
Prescott, AZ 86301-2411 - Phone
- (925) 445-5211
- NPI assigned
- Sep 22, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-21373 | AZ | Primary |
Addresses
Primary practice location
642 Dameron Dr
Prescott, AZ 86301-2411
Mailing address
642 Dameron Dr
Prescott, AZ 86301-2411
Phone (928) 445-5211
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-21373 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1942089693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "642 DAMERON DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863012411",
"telephone_number": "928-445-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "642 DAMERON DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863012411",
"telephone_number": "925-445-5211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIBBLE",
"first_name": "AMY",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-22",
"last_updated": "2023-09-22",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW-21373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.