Healthcare Provider Details

I. General information

NPI: 1699172130
Provider Name (Legal Business Name): AMANDA BETH JANULIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BETSY LN
AMBLER PA
19002-5733
US

IV. Provider business mailing address

32 BETSY LN
AMBLER PA
19002-5733
US

V. Phone/Fax

Practice location:
  • Phone: 215-287-6690
  • Fax:
Mailing address:
  • Phone: 215-287-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCW014691
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06112700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124779
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014817
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012026
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014691
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: