Provider Demographics
NPI:1710221569
Name:COLE, AMANDA M (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-8502
Mailing Address - Country:US
Mailing Address - Phone:814-873-4422
Mailing Address - Fax:
Practice Address - Street 1:2520 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-8502
Practice Address - Country:US
Practice Address - Phone:814-873-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129419104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker