Healthcare Provider Details

I. General information

NPI: 1841657368
Provider Name (Legal Business Name): AMANDA GRACE LAMB MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E WASHINGTON ST
LEBANON IN
46052-2210
US

IV. Provider business mailing address

10466 KINGS GAP WAY
INDIANAPOLIS IN
46234-3647
US

V. Phone/Fax

Practice location:
  • Phone: 765-680-0071
  • Fax:
Mailing address:
  • Phone: 317-523-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99069845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: