Provider Demographics
NPI:1013319839
Name:SMITH, AMANDA (MSS, LCSW, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSS, LCSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PILGRIM LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5000
Mailing Address - Country:US
Mailing Address - Phone:484-476-6543
Mailing Address - Fax:484-450-0090
Practice Address - Street 1:401 PILGRIM LN
Practice Address - Street 2:SUITE 103
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5000
Practice Address - Country:US
Practice Address - Phone:484-476-6543
Practice Address - Fax:484-450-0090
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical