Provider Demographics
NPI:1619416310
Name:KASTELIC, AMANDA NICHOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICHOLE
Last Name:KASTELIC
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 1:800 HERTEL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1906
Mailing Address - Country:US
Mailing Address - Phone:716-566-5050
Mailing Address - Fax:
Practice Address - Street 1:14014 ROUTE 31
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411
Practice Address - Country:US
Practice Address - Phone:585-589-7066
Practice Address - Fax:585-589-6395
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102556-1104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker