Healthcare Provider Details

I. General information

NPI: 1730132317
Provider Name (Legal Business Name): AMANDA LEWELLEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MEDIC WAY
GREENCASTLE IN
46135-2296
US

IV. Provider business mailing address

12269 STATE HIGHWAY 243
CLOVERDALE IN
46120-8019
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-2669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: