Provider Demographics
NPI:1821260993
Name:AMANATIDES, NANCYANNE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:NANCYANNE
Middle Name:
Last Name:AMANATIDES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:NANCYANNE
Other - Middle Name:J
Other - Last Name:DERIENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW/R
Mailing Address - Street 1:169 NEPTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3729
Mailing Address - Country:US
Mailing Address - Phone:516-432-0292
Mailing Address - Fax:516-432-0292
Practice Address - Street 1:169 NEPTUNE BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3729
Practice Address - Country:US
Practice Address - Phone:516-432-0292
Practice Address - Fax:516-432-0292
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0469631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical