Healthcare Provider Details

I. General information

NPI: 1982388492
Provider Name (Legal Business Name): AMANDA ELIZABETH CAHALL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/17/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LUPTON AVE
WOODBURY NJ
08096-5901
US

IV. Provider business mailing address

129 MINUTEMAN LN
SWEDESBORO NJ
08085-4237
US

V. Phone/Fax

Practice location:
  • Phone: 856-693-5775
  • Fax:
Mailing address:
  • Phone: 856-803-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06827700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: