Provider Demographics
NPI:1003182049
Name:NIELSEN, AMANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 APPLE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3527
Mailing Address - Country:US
Mailing Address - Phone:775-525-0270
Mailing Address - Fax:
Practice Address - Street 1:495 APPLE ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3527
Practice Address - Country:US
Practice Address - Phone:775-525-0270
Practice Address - Fax:775-432-6150
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9876-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical