Provider Demographics
NPI:1669931341
Name:ADHAMI, AMANDA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ADHAMI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 CREEKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2091
Mailing Address - Country:US
Mailing Address - Phone:812-369-9128
Mailing Address - Fax:
Practice Address - Street 1:645 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3846
Practice Address - Country:US
Practice Address - Phone:812-336-3570
Practice Address - Fax:812-336-9010
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IN33008127A103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33008218AOtherCOMMERCIAL
IN33008218AMedicaid
IN34009199AMedicaid