Provider Demographics
NPI:1912013772
Name:PENTZER, AMANDA (LISW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PENTZER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0111
Mailing Address - Country:US
Mailing Address - Phone:614-885-2411
Mailing Address - Fax:614-885-2453
Practice Address - Street 1:885 HIGH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4158
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:614-882-3401
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI05001661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPESW30231Medicare ID - Type Unspecified