Provider Demographics
NPI:1740444785
Name:TRUSSELL, AMY CATHERINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CATHERINE
Last Name:TRUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:CATHERINE
Other - Last Name:GIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12111 SUGARLOAF KEY ST APT 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2746
Mailing Address - Country:US
Mailing Address - Phone:217-853-0006
Mailing Address - Fax:
Practice Address - Street 1:12111 SUGARLOAF KEY ST APT 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2746
Practice Address - Country:US
Practice Address - Phone:217-853-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0120401041C0700X
FLSW115511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical