Provider Demographics
NPI:1629326723
Name:BEBEAU, AMANDA S (MSW, LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:S
Last Name:BEBEAU
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4803
Mailing Address - Country:US
Mailing Address - Phone:419-318-5286
Mailing Address - Fax:
Practice Address - Street 1:4159 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4803
Practice Address - Country:US
Practice Address - Phone:419-318-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1200760104100000X
OHI.14511081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0190818Medicaid
OH0190818Medicaid