Provider Demographics
NPI:1952943011
Name:GLYNN, AMANDA LEE (LSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:GLYNN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1109
Mailing Address - Country:US
Mailing Address - Phone:973-919-9348
Mailing Address - Fax:
Practice Address - Street 1:84 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1172
Practice Address - Country:US
Practice Address - Phone:908-751-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06490300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker