Provider Demographics
NPI:1578799920
Name:RANDALL, AMANDA DUFFY (PHD, LSCW)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DUFFY
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHD, LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 PACIFIC ST STE 323
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5480
Mailing Address - Country:US
Mailing Address - Phone:402-390-6007
Mailing Address - Fax:
Practice Address - Street 1:7701 PACIFIC STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-390-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1631041C0700X
NE23161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical