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General NPI Number Information
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NPI Number | 1194388363
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Entity Type | Individual
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Provider Name | AMANDA BRACY LSW
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 2775 STATE ROUTE 39
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City | SHELBY
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State | OH
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Zip | 44875-9466
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Country | US
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Telephone | 419-747-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 103 N UNION ST APT 1
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City | GALION
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State | OH
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Zip | 44833-1746
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2106078
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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