Provider Demographics
NPI:1851675375
Name:PETRUNAK, AMANDA NICOLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:PETRUNAK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:RAVIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:702 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-2004
Mailing Address - Country:US
Mailing Address - Phone:724-230-3242
Mailing Address - Fax:724-230-3270
Practice Address - Street 1:702 2ND AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-2004
Practice Address - Country:US
Practice Address - Phone:724-230-3242
Practice Address - Fax:724-230-3270
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker