Healthcare Provider Details

I. General information

NPI: 1235060112
Provider Name (Legal Business Name): AMANDA GAUDET LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 23RD AVE # 25
ASTORIA NY
11105-2775
US

IV. Provider business mailing address

2810 23RD AVE # 25
ASTORIA NY
11105-2775
US

V. Phone/Fax

Practice location:
  • Phone: 347-850-0328
  • Fax:
Mailing address:
  • Phone: 347-850-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GAUDET
Title or Position: MEMBER-MANAGER
Credential: LCSW
Phone: 978-270-2990