Healthcare Provider Details

I. General information

NPI: 1013319839
Provider Name (Legal Business Name): AMANDA SMITH MSS, LCSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ANDORRA GLEN COURT OFFICE SUITE 12
LAFAYETTE HILL PA
19444
US

IV. Provider business mailing address

555 ANDORRA GLEN COURT OFFICE SUITE 12
LAFAYETTE HILL PA
19444
US

V. Phone/Fax

Practice location:
  • Phone: 484-354-7162
  • Fax:
Mailing address:
  • Phone: 484-354-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: