=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457150849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY CORWIN
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7475 HALCYON POINTE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-8053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-954-6010
-----------------------------------------------------
Fax | 334-649-6399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7475 HALCYON POINTE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-8053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-954-6010
-----------------------------------------------------
Fax | 334-649-6399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6058C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------