MEDICARE: AMANDA E NORTHROP 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
1	104100000X	Social Worker	086187	NY
2	1041C0700X	Clinical Social Worker	11518	CT

General Provider Information

NPI Number	:	1255637955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA E NORTHROP LCSW

Provider Business Mailing Address
First Line	:	25 WITCH LN
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 WITCH LN
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1234
Country	:	US
Telephone Number	:	914-548-4435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/11/2024

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Directions to “ AMANDA E NORTHROP LCSW” Practice Location

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