Healthcare Provider Details

I. General information

NPI: 1669720280
Provider Name (Legal Business Name): AMANDA KEANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CONSTANTINO

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 8TH ST
DELMAR DE
19940-1374
US

IV. Provider business mailing address

200 N 8TH ST
DELMAR DE
19940-1374
US

V. Phone/Fax

Practice location:
  • Phone: 302-846-0303
  • Fax: 302-846-0502
Mailing address:
  • Phone: 302-846-0303
  • Fax: 302-846-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001166
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: