Provider Demographics
NPI:1013119775
Name:ABDNOUR, AMY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:ABDNOUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S. HOOVER BLVD. STE. 185
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3544
Mailing Address - Country:US
Mailing Address - Phone:813-679-3845
Mailing Address - Fax:
Practice Address - Street 1:200 S HOOVER BLVD STE 185
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3544
Practice Address - Country:US
Practice Address - Phone:813-679-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 82011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical