Provider Demographics
NPI:1164192258
Name:PENSA, AMANDA MOIRA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MOIRA
Last Name:PENSA
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 1:433 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3119
Mailing Address - Country:US
Mailing Address - Phone:516-695-2944
Mailing Address - Fax:
Practice Address - Street 1:99 TULIP AVE STE 402
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1974
Practice Address - Country:US
Practice Address - Phone:516-695-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0870821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical