Provider Demographics
NPI:1184190316
Name:ROYCE, AMANDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ROYCE
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 1:4332 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6648
Mailing Address - Country:US
Mailing Address - Phone:480-326-6211
Mailing Address - Fax:
Practice Address - Street 1:4332 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-6648
Practice Address - Country:US
Practice Address - Phone:480-326-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-157671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical