Healthcare Provider Details

I. General information

NPI: 1770843021
Provider Name (Legal Business Name): AMANDA R WEATHERMAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S INDIAN RIVER DR STE 202
FORT PIERCE FL
34950-4353
US

IV. Provider business mailing address

2618 TOLMAN AVE SE
PALM BAY FL
32909-7220
US

V. Phone/Fax

Practice location:
  • Phone: 772-773-0229
  • Fax:
Mailing address:
  • Phone: 772-579-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25317
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: