Provider Demographics
NPI:1821531195
Name:ELLER, AMANDA L (MS, LSW, C-SSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:ELLER
Suffix:
Gender:F
Credentials:MS, LSW, C-SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 ROUTE 47 S STE 9
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1609
Mailing Address - Country:US
Mailing Address - Phone:609-486-2003
Mailing Address - Fax:
Practice Address - Street 1:1127 ROUTE 47 S STE 9
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1609
Practice Address - Country:US
Practice Address - Phone:609-468-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06221500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health