Provider Demographics
NPI:1477688786
Name:ZAIDMAN, AMANDA JILL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JILL
Last Name:ZAIDMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JILL
Other - Last Name:CAPANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3315 SPRINGBANK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3197
Mailing Address - Country:US
Mailing Address - Phone:704-413-3323
Mailing Address - Fax:
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3197
Practice Address - Country:US
Practice Address - Phone:704-413-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAZ61984Medicaid