Provider Demographics
NPI:1275876237
Name:MEYER, AMANDA MARINA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARINA
Last Name:MEYER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 108TH AVE NE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5562
Mailing Address - Country:US
Mailing Address - Phone:425-454-1199
Mailing Address - Fax:425-454-8779
Practice Address - Street 1:400 108TH AVE NE
Practice Address - Street 2:SUITE 402
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5562
Practice Address - Country:US
Practice Address - Phone:425-454-1199
Practice Address - Fax:425-454-8779
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60329141104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker