Provider Demographics
NPI:1205454329
Name:FARRIS, AMANDA JENNINGS (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JENNINGS
Last Name:FARRIS
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 1:720 BROOKER CREEK BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2937
Mailing Address - Country:US
Mailing Address - Phone:813-854-9136
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:4911 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3429
Practice Address - Country:US
Practice Address - Phone:813-471-9709
Practice Address - Fax:813-872-7766
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW173201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical