Provider Demographics
NPI:1700298239
Name:CROSS, AMANDA ELIZABETH JONES (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH JONES
Last Name:CROSS
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 1:3812 ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3513
Mailing Address - Country:US
Mailing Address - Phone:619-675-6900
Mailing Address - Fax:
Practice Address - Street 1:1068 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2309
Practice Address - Country:US
Practice Address - Phone:619-675-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical