Provider Demographics
NPI:1659602464
Name:PERRYMAN, AMANDA LEE (LSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:REAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:317 LADDIE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1334
Mailing Address - Country:US
Mailing Address - Phone:412-260-5698
Mailing Address - Fax:
Practice Address - Street 1:317 LADDIE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-1334
Practice Address - Country:US
Practice Address - Phone:412-260-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126781104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker