Healthcare Provider Details

I. General information

NPI: 1497207682
Provider Name (Legal Business Name): AMANDA SANNEH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LASANE ALI LICSW

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21727 76TH AVE W STE C
EDMONDS WA
98026-7549
US

IV. Provider business mailing address

725 ALBANY ST FL 9
BOSTON MA
02118-3549
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-6021
  • Fax: 206-260-2903
Mailing address:
  • Phone: 617-414-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70055041
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number222190
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: