Provider Demographics
NPI:1982200986
Name:LEE, AMANDA RAE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 N COUNTY ROAD 800 W
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7153
Mailing Address - Country:US
Mailing Address - Phone:765-914-8887
Mailing Address - Fax:
Practice Address - Street 1:2151 LAFAYETTE AVE, SUITE 105
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805
Practice Address - Country:US
Practice Address - Phone:812-814-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical