MEDICARE: AMANDA KRISTEN ADILI

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	082340	NY

General Provider Information

NPI Number	:	1619284957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KRISTEN ADILI

Provider Business Mailing Address
First Line	:	447 15TH ST # 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5703
Country	:	US
Telephone Number	:	212-989-2990
Fax Number	:	212-792-6058

Provider Business Practice Location Address
First Line	:	447 15TH ST # 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5703
Country	:	US
Telephone Number	:	212-989-2990
Fax Number	:	212-792-6058

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/18/2014

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