Healthcare Provider Details

I. General information

NPI: 1760072433
Provider Name (Legal Business Name): AMANDA GOOD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 C CT
ASHTABULA OH
44004-4577
US

IV. Provider business mailing address

3418 LAKE AVE
ASHTABULA OH
44004-5763
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.161765
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: