Provider Demographics
NPI:1396985438
Name:DE JESUS, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DE JESUS
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 1:300 W 55TH ST
Mailing Address - Street 2:#15X
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5172
Mailing Address - Country:US
Mailing Address - Phone:631-716-4386
Mailing Address - Fax:
Practice Address - Street 1:300 W 55TH ST
Practice Address - Street 2:#15X
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5172
Practice Address - Country:US
Practice Address - Phone:631-716-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076251-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331946Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331043Medicare Oscar/Certification