Provider Demographics
NPI:1700032257
Name:CLARK-ANDREJKOVICS, AMANDA JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JANE
Last Name:CLARK-ANDREJKOVICS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:CLARK-ASHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PSC 41
Mailing Address - Street 2:BOX 1355
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 MDG
Practice Address - Street 2:UNIT 5210
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:US
Practice Address - Phone:01144163-852-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW90921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical