Provider Demographics
NPI:1033692785
Name:DEPAOLO, AMANNDA (LICSW)
Entity Type:Individual
Prefix:
First Name:AMANNDA
Middle Name:
Last Name:DEPAOLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4611
Mailing Address - Country:US
Mailing Address - Phone:781-388-0882
Mailing Address - Fax:
Practice Address - Street 1:29 WESCOTT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4611
Practice Address - Country:US
Practice Address - Phone:781-388-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1172501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical