Provider Demographics
NPI:1740919554
Name:AMANDA STAMM, LMSW
Entity type:Organization
Organization Name:AMANDA STAMM, LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-381-3603
Mailing Address - Street 1:28212 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2496
Mailing Address - Country:US
Mailing Address - Phone:158-638-1360
Mailing Address - Fax:
Practice Address - Street 1:28212 EDWARD ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2496
Practice Address - Country:US
Practice Address - Phone:115-863-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty