Provider Demographics
NPI:1649985334
Name:MANSKE, AMANDA (LCSW, RPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MANSKE
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 SW MAIN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5742
Mailing Address - Country:US
Mailing Address - Phone:386-984-5366
Mailing Address - Fax:386-287-6525
Practice Address - Street 1:826 SW MAIN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5742
Practice Address - Country:US
Practice Address - Phone:386-984-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW191701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical