Provider Demographics
NPI:1770140378
Name:AMANDA WARE, LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:AMANDA WARE, LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-600-4849
Mailing Address - Street 1:7349 MILLIKEN AVE. #140-260
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-600-4849
Mailing Address - Fax:
Practice Address - Street 1:9333 FAIRWAY VIEW PLACE SUITE 101
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-600-4849
Practice Address - Fax:909-296-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty