Provider Demographics
NPI:1770737314
Name:STRATTON KIRK, AMANDA J (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:STRATTON KIRK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CENTENNIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7939
Mailing Address - Country:US
Mailing Address - Phone:978-927-9410
Mailing Address - Fax:978-531-1355
Practice Address - Street 1:9 CENTENNIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7939
Practice Address - Country:US
Practice Address - Phone:978-927-9410
Practice Address - Fax:978-531-1355
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2144281041C0700X
MA11717501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical