Provider Demographics
NPI:1598177727
Name:SECRAN-MANSILLA, AMANDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:SECRAN-MANSILLA
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 1:5201 MILL STREAM RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-8121
Mailing Address - Country:US
Mailing Address - Phone:407-334-4748
Mailing Address - Fax:
Practice Address - Street 1:7350 FUTURES DR STE 18
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9084
Practice Address - Country:US
Practice Address - Phone:407-334-4748
Practice Address - Fax:321-236-7097
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical