Healthcare Provider Details

I. General information

NPI: 1750683553
Provider Name (Legal Business Name): AMANDA CUSHING MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CONCORD AVE STE 1
ST JOHNSBURY VT
05819-1515
US

IV. Provider business mailing address

231 CONCORD AVE STE 1
ST JOHNSBURY VT
05819-1515
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-5364
  • Fax: 802-748-7289
Mailing address:
  • Phone: 802-748-5364
  • Fax: 802-748-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890071950
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: