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General NPI Number Information
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NPI Number | 1912509951
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Entity Type | Individual
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Provider Name | AMANDA DENISE BODY LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 411 E CHESTNUT ST # 4B
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City | LOUISVILLE
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State | KY
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Zip | 40202-1713
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Country | US
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Telephone | 502-588-3600
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Fax | 502-588-9536
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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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 | 255216
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License Number State | KY
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