Provider Demographics
NPI:1982192639
Name:ARYA, AMANDA CHRISTINE (LMSW, CSW-INTERN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:ARYA
Suffix:
Gender:F
Credentials:LMSW, CSW-INTERN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:ENDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2629 PORTLAND ST APT 104B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-4818
Mailing Address - Country:US
Mailing Address - Phone:313-285-0098
Mailing Address - Fax:
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:775-624-8222
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2023-10-17
Deactivation Date:2023-10-11
Deactivation Code:
Reactivation Date:2023-10-17
Provider Licenses
StateLicense IDTaxonomies
NV10067-M104100000X
IC-20311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker