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General NPI Number Information
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NPI Number | 1972046647
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Entity Type | Organization
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Legal Business Name | AMANDA JELDEN, LCSW LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 18 ONECO ST SUITE 3
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City | NORWICH
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State | CT
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Zip | 06360-3440
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Country | US
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Telephone | 860-334-9264
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Fax |
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Provider Business Mailing Address
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Address Line | 18 ONECO ST SUITE 3
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City | NORWICH
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State | CT
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Zip | 06360-3440
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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 | CLINICIAN
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Name | AMANDA JELDEN
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Credential |
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Telephone | 860-334-9264
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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 | 58.009625
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License Number State | CT
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