AMY ELIZABETH PRUDENCIO (NPI# 1295244242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295244242 |
| Entity Type | Individual |
| Full Name | AMY ELIZABETH PRUDENCIO |
| Credential | LCSW |
| Practice Address |
1301 E. Walnut Street Carbondale IL 62901 |
| Mailing Address |
1301 E Walnut St Carbondale IL 62901-5004 |
| Practice Telephone | (618) 457-3371 |
| Practice Fax Number | 6185491608 |
| Mailing Telephone | 6184573371 |
| Mailing Fax Number | 6185491608 |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2017-09-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041S0200X |
Social Worker Specialization: School |
149014863 | IL | Behavioral Health & Social Service Providers |
| Street Address |
1301 E. WALNUT STREET |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| 1174919351 | Southern Illinois University Carbondale Clinical Center | Psychologist | 625 Wham Drive Room 141, Carbondale, IL 62901 | 2015-04-14 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 1041S0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366059818 | Amy D Ruckman | Social Worker | 407 S Edwards St, Altamont, IL 62411-1799 | 2020-09-29 |
| 1568080612 | Jordan Coleman | Social Worker | 1421 Marshall Ave, Mattoon, IL 61938-5341 | 2020-07-06 |
| 1164063632 | John Naret | Social Worker | 9130 S 52nd Ave, Oak Lawn, IL 60453-1799 | 2019-10-04 |
| 1306496393 | Marie Nagle | Social Worker | 6316 157th St, Oak Forest, IL 60452-2710 | 2019-09-12 |
| 1639641376 | Brandon Christensen | Social Worker | 110 Collins St, Joliet, IL 60432-2942 | 2018-12-19 |
| 1558847335 | Inner Balance Wellness | Social Worker | 303 E Army Trail Rd Ste 207, Bloomingdale, IL 60108-2143 | 2018-07-16 |
| 1538675244 | Mary Elizabeth Hall | Social Worker | 411 Stave Mill Rd, Murphysboro, IL 62966-4888 | 2017-12-18 |
| 1184133084 | Andrea Lynn Geis | Social Worker | 50 Blackwood Dr, Murphysboro, IL 62966-2937 | 2017-09-22 |
| 1528587318 | Jaclyn Hood | Social Worker | 3945 Wehrman, Schiller Park, IL 60176 | 2017-09-13 |
| 1063930675 | Haley Estes | Social Worker | 413 N. Appleknocker Drive, Cobden, IL 62920 | 2017-09-04 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on AMY ELIZABETH PRUDENCIO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.