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NPI Code Detail

MEDICARE: AMANDA FROSTAD LCSW

MEDICARE: AMANDA FROSTAD LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial Worker
31041C0700XClinical Social Worker097748NY

General Provider Information

NPI Number : 1225696743
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FROSTAD LCSW
Provider Business Mailing Address
First Line : 324 COUNTY ROUTE 51 BLDG 1
Second Line :
City : MALONE
State : NY
Zip : 12953-4502
Country : US
Telephone Number : 315-376-5450
Fax Number : 315-779-5028
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2019
Last Update Date : 04/04/2025

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Directions to “ AMANDA FROSTAD LCSW” Practice Location

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