Provider Demographics
NPI:1538671904
Name:BAIRD, AMANDA (LADC-1, LICSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LADC-1, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROUTE 134 STE 7B
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-3818
Mailing Address - Country:US
Mailing Address - Phone:508-360-3288
Mailing Address - Fax:
Practice Address - Street 1:38 ROUTE 134 STE 7B
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3818
Practice Address - Country:US
Practice Address - Phone:508-360-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MALICSW1265561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty