Healthcare Provider Details

I. General information

NPI: 1982488433
Provider Name (Legal Business Name): AMANDA ANN MORAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 NORWOOD AVENUE
CRANSTON RI
02905-3923
US

IV. Provider business mailing address

178 NORWOOD AVE
CRANSTON RI
02905-3923
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-1470
  • Fax: 401-921-4515
Mailing address:
  • Phone: 401-677-8072
  • Fax: 401-921-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04988
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: