MEDICARE: MRS. AMANDA JO WARE MSW

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
1	1041C0700X	Clinical Social Worker	8600-C	NV
2	1041C0700X	Clinical Social Worker	LCSW69991	CA

General Provider Information

NPI Number	:	1255564845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA JO WARE MSW

Provider Business Mailing Address
First Line	:	7349 MILLIKEN AVE # 140-260
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-7435
Country	:	US
Telephone Number	:	909-600-4849
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE B6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6802
Country	:	US
Telephone Number	:	702-447-0514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	07/24/2020

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