Provider Demographics
NPI:1639450349
Name:GANE, AMANDA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:GANE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 ANTIGO LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2044
Mailing Address - Country:US
Mailing Address - Phone:708-714-2644
Mailing Address - Fax:512-359-8261
Practice Address - Street 1:6408 ANTIGO LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2044
Practice Address - Country:US
Practice Address - Phone:087-142-6447
Practice Address - Fax:512-359-8261
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical