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NPI Code Detail

MEDICARE: AMANDA LEIGH DELONG LCSW

MEDICARE:   AMANDA LEIGH DELONG  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker9309-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225583313
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEIGH DELONG LCSW
Provider Business Mailing Address
First Line : W175N11120 STONEWOOD DR
Second Line :
City : GERMANTOWN
State : WI
Zip : 53022-6511
Country : US
Telephone Number : 800-438-1772
Fax Number : 262-293-9737
Provider Business Practice Location Address
First Line : 3040 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2618
Country : US
Telephone Number : 800-438-1772
Fax Number : 262-293-9737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2016
Last Update Date : 12/27/2019

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Directions to “ AMANDA LEIGH DELONG LCSW” Practice Location

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