Amanda Marie Blake, LICSW, MSSW
NPI 1174773469ActiveIndividual· Social Worker, Clinical· Grand Forks, ND
Social Worker, Clinical (LICSW, MSSW) with Lipp Carlson Witucki and Associates Ltd, practicing in Grand Forks, North Dakota. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1174773469 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LICSW, MSSW |
| Sole proprietor | No |
| NPI issued | Sep 24, 2008 |
| Last updated in NPPES | Oct 31, 2022 |
| Certified by provider | Oct 31, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 4753 | ND |
| Social Worker | 104100000X | 4753 | ND |
| Social Worker | 104100000X | 50864 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (ND) |
|---|
Education and affiliations
| Graduation year | 2002 |
|---|---|
| Medicare specialty | Clinical Social Worker |
| Telehealth | Offers telehealth |
Medical group
- Lipp Carlson Witucki and Associates LtdGrand Forks, ND · 10 clinicians
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All 134 clinical social workers in Grand Forks · All clinical social workers in North Dakota