Amanda Divis, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I1501241 Issued in OH

Practice address

3950 Chester Ave
Cleveland, OH 44114-4625

Phone

(216) 431-4131

Fax

(216) 431-4151

NPI assigned

Apr 22, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Bolton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1962822577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 CHESTER AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441144625",
            "telephone_number": "216-431-4131",
            "fax_number": "216-431-4151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 CHESTER AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441144625",
            "telephone_number": "216-431-4131",
            "fax_number": "216-431-4151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVIS",
        "first_name": "AMANDA",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-22",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1501241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BOLTON",
            "credential": "LSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gabriella Marie Diturno, PA-C
• Frank J Ditzig, DDS
• Sakina Divan
• Diverge Health Aco of Heartland Ohio
• Lola Divincenzo, DO, MS
• Anthony Ernest Divito
• Gouri B Diwadkar, MD
• Harmoni N Dix
• Shweta Dixit, MD
• Beth G Dixon, PSYD

• Clinical Social Worker in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.