Healthcare Provider Details

I. General information

NPI: 1639781461
Provider Name (Legal Business Name): AERIAL AMOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AERIAL DAYSHA MALDONADO-VELEZ LCSW

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

IV. Provider business mailing address

120 APPLEBY ST NE
PALM BAY FL
32907-3027
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5700
  • Fax: 866-521-0526
Mailing address:
  • Phone: 910-624-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65965
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number65965
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19093
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022818
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW19093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: