Provider Demographics
NPI:1982858676
Name:SPAULDING, AMANDA DURRELL (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DURRELL
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W COURT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4165
Mailing Address - Country:US
Mailing Address - Phone:607-256-4422
Mailing Address - Fax:
Practice Address - Street 1:122 W COURT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4165
Practice Address - Country:US
Practice Address - Phone:607-256-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR053077-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical