Provider Demographics
NPI:1790342020
Name:BENLIEN, AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BENLIEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21387 MEEHAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4204
Mailing Address - Country:US
Mailing Address - Phone:413-329-2150
Mailing Address - Fax:
Practice Address - Street 1:21387 MEEHAN AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4204
Practice Address - Country:US
Practice Address - Phone:413-329-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical