Provider Demographics
NPI:1295222644
Name:OWENS, AMANDA (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TETREAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 UNION ST
Mailing Address - Street 2:STE G02
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1138
Mailing Address - Country:US
Mailing Address - Phone:508-755-0333
Mailing Address - Fax:
Practice Address - Street 1:4 MANN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3414
Practice Address - Country:US
Practice Address - Phone:508-755-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC209321041C0700X
VA09040138721041C0700X
MA1211881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical