Amanda Lee Carrillo, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Fullerton, California. Her current practice location is
3621 W Ash Ave, Fullerton, California. You can reach out to her office (for appointments etc.) via phone at
(714) 872-0034.
Amanda Lee Carrillo is licensed to practice in California (license number LCSW82461) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1477804227.
Healthcare Provider's Profile
| Full Name | Amanda Lee Carrillo |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3621 W Ash Ave, Fullerton, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1477804227
- Provider Enumeration Date: 09/19/2012
- Last Update Date: 11/29/2019
Medicare PECOS Information:
- PECOS PAC ID: 5193248425
- Enrollment ID: I20250327002452
Medical Identifiers
Medical identifiers for Amanda Lee Carrillo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1477804227 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | ASW36736 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW82461 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Amanda Lee Carrillo allows following entities to bill medicare on her behalf.
| Entity Name | Medard Sison Np, A Professional Nursing Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1528693579
PECOS PAC ID: 5294151635
Enrollment ID: O20200817002415 |
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| Entity Name | Renewed Community Mental Health |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912736026
PECOS PAC ID: 0244760882
Enrollment ID: O20250211003349 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Amanda Lee Carrillo is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Amanda Lee Carrillo, LCSW
3621 W Ash Ave,
Fullerton, CA 92833-3107
Ph: (714) 872-0034 | Amanda Lee Carrillo, LCSW
3621 W Ash Ave,
Fullerton, CA 92833-3107
Ph: (714) 872-0034 |
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