=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831587401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA LEONE LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2015
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 S WHITE HORSE PIKE
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-617-4544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 739 S WHITE HORSE PIKE STE 10
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08106-1659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-617-4544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL06316600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------