Provider Demographics
NPI:1629663893
Name:TAYLOR, AMANDA NICHOLE (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICHOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:NICHOLE
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-0664
Mailing Address - Country:US
Mailing Address - Phone:330-744-9020
Mailing Address - Fax:
Practice Address - Street 1:100 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2789
Practice Address - Country:US
Practice Address - Phone:307-449-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.18023901041C0700X
OHI.22040691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical