Provider Demographics
NPI:1720506165
Name:CUSWORTH, AMANDA JANE (LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:CUSWORTH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:KELLEGHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:38W461 CALLIGHAN PL
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-6071
Mailing Address - Country:US
Mailing Address - Phone:630-697-8316
Mailing Address - Fax:
Practice Address - Street 1:321 FRANKLIN ST STE B
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2664
Practice Address - Country:US
Practice Address - Phone:630-697-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker