Active NPI
Amy Wallerstein Friedman, L.C.S.W.
- Clinical Social Worker
- Oakland, CA
National Provider Identifier
1982790507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 11194
- Practice address
- 17 Glen Eden Ave.
Oakland, CA 94611 - Phone
- (510) 482-9889
- Fax
- (510) 749-9136
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | LCS 11194 | CA | Primary |
Addresses
Primary practice location
17 Glen Eden Ave.
Oakland, CA 94611
Mailing address
17 Glen Eden Ave.
Oakland, CA 94611
Phone (510) 482-9889
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCS 11194 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 11194 | CA | MD | Clinical Social Worker |
| 11194 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982790507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 GLEN EDEN AVE.",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94611",
"telephone_number": "510-482-9889",
"fax_number": "510-749-9136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 GLEN EDEN AVE.",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94611",
"telephone_number": "510-482-9889",
"fax_number": "510-749-9136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRIEDMAN",
"first_name": "AMY",
"middle_name": "WALLERSTEIN",
"name_prefix": "Mrs.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 11194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "LCS 11194",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.