Healthcare Provider Details

I. General information

NPI: 1184054736
Provider Name (Legal Business Name): AMANDA WAYNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PARK AVE
FLEMINGTON NJ
08822-1319
US

IV. Provider business mailing address

900 ROUTE168, SUITED2 WASHINGTON PROFESSIONAL CAMPUS
TURNERSVILLE NJ
08012-1125
US

V. Phone/Fax

Practice location:
  • Phone: 908-782-7905
  • Fax: 908-782-5934
Mailing address:
  • Phone: 856-352-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC04505400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04505400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: