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General NPI Number Information
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NPI Number | 1790390771
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Entity Type | Individual
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Provider Name | AMANDA WELTY LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 157 GREEN ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2667
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Country | US
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Telephone | 617-309-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 289 WALK HILL ST UNIT 301
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City | ROSLINDALE
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State | MA
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Zip | 02131-3254
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Country | US
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Telephone | 719-229-4870
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 128246
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License Number State | MA
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