MEDICARE: MS. AMANDA REYNOLDS 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

General Provider Information

NPI Number	:	1710591755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA REYNOLDS LCSW

Provider Business Mailing Address
First Line	:	12 CARDINAL CT
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-2505
Country	:	US
Telephone Number	:	201-835-7949
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 FOREST AVE
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-5237
Country	:	US
Telephone Number	:	201-588-3491
Fax Number	:

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

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	03/10/2025

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