Provider Demographics
NPI:1679059448
Name:MORTEO, AMANDA H (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:H
Last Name:MORTEO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:H
Other - Last Name:MOOERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 E 2ND ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1587
Mailing Address - Country:US
Mailing Address - Phone:631-835-9259
Mailing Address - Fax:
Practice Address - Street 1:1035 CAMBRIDGE ST STE 26
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1154
Practice Address - Country:US
Practice Address - Phone:617-806-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1206021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical