MEDICARE: MRS. AMANDA DENHAM JURIST 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	1041C0700X	Clinical Social Worker	75897	CA
2	1041C0700X	Clinical Social Worker	086432	NY

General Provider Information

NPI Number	:	1811470891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA DENHAM JURIST LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10150-0003
Country	:	US
Telephone Number	:	310-228-7360
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 W OLYMPIC BLVD STE 405
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5002
Country	:	US
Telephone Number	:	424-259-1032
Fax Number	:

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

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	09/14/2018

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Directions to “ MRS. AMANDA DENHAM JURIST LCSW” Practice Location

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