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General NPI Number Information
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NPI Number | 1104331156
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Entity Type | Organization
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Legal Business Name | AMANDA T PAUL, LCSW, MT-BC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 4523 GREYMONT DR
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City | LOUISVILLE
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State | KY
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Zip | 40229-3588
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Country | US
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Telephone | 502-640-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 4523 GREYMONT DR
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City | LOUISVILLE
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State | KY
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Zip | 40229-3588
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Country | US
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Telephone | 502-640-3940
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | AMANDA THOMASON PAUL
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Credential | LCSW, MT-BC
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Telephone | 502-640-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3813
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License Number State | KY
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