Provider Demographics
NPI:1649739202
Name:WESTFALL, AMANDA E (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:WESTFALL
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:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-0792
Mailing Address - Country:US
Mailing Address - Phone:845-239-2084
Mailing Address - Fax:
Practice Address - Street 1:136 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2611
Practice Address - Country:US
Practice Address - Phone:845-239-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0851031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherPRIVATE INSURANCE