Healthcare Provider Details

I. General information

NPI: 1790014298
Provider Name (Legal Business Name): AMANDA JILL ZAVODNICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 GERMANTOWN AVE 5TH FLOOR
PHILADELPHIA PA
19118-2722
US

IV. Provider business mailing address

8815 GERMANTOWN AVE 5TH FLOOR
PHILADELPHIA PA
19118-2722
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8145
  • Fax: 215-248-8852
Mailing address:
  • Phone: 215-248-8145
  • Fax: 215-248-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015865
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: