Provider Demographics
NPI:1396362976
Name:SMITH, AMANDA R (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:SMITH
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 1:139 OLD MINISINK TRL
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6922
Mailing Address - Country:US
Mailing Address - Phone:845-283-0690
Mailing Address - Fax:
Practice Address - Street 1:5 HDSN VLY PROF PLZ
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3150
Practice Address - Country:US
Practice Address - Phone:845-595-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical