Provider Demographics
NPI:1184263386
Name:SANDER, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SANDER
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 1:173 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:FORT ANN
Mailing Address - State:NY
Mailing Address - Zip Code:12827-5315
Mailing Address - Country:US
Mailing Address - Phone:518-321-4563
Mailing Address - Fax:
Practice Address - Street 1:268 BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4256
Practice Address - Country:US
Practice Address - Phone:888-454-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102061104100000X
NY0927711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker