Provider Demographics
NPI:1184221020
Name:ENRIGHT, AMANDA (LICSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ENRIGHT
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 1:1361 BACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5017
Mailing Address - Country:US
Mailing Address - Phone:802-356-1773
Mailing Address - Fax:
Practice Address - Street 1:1361 BACK RIVER RD
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068-5017
Practice Address - Country:US
Practice Address - Phone:802-356-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01187501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty