MEDICARE: AMANDA EARHART 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
1	104100000X	Social Worker	LCSW00001112	KY
2	1041C0700X	Clinical Social Worker	I.2002027	OH

General Provider Information

NPI Number	:	1538684303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA EARHART LCSW

Provider Business Mailing Address
First Line	:	4465 ALEXANDRIA PIKE
Second Line	:
City	:	COLD SPRING
State	:	KY
Zip	:	41076-1901
Country	:	US
Telephone Number	:	859-635-5272
Fax Number	:	859-635-6032

Provider Business Practice Location Address
First Line	:	4465 ALEXANDRIA PIKE
Second Line	:
City	:	COLD SPRING
State	:	KY
Zip	:	41076-1901
Country	:	US
Telephone Number	:	859-635-5272
Fax Number	:	859-635-6032

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

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	10/02/2025

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