MEDICARE: AMANDA BARNETT, LCSW, INC

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	251S00000X	Community/Behavioral Health Agency	LCS18037	CA

General Provider Information

NPI Number	:	1255710281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA BARNETT, LCSW, INC

Provider Business Mailing Address
First Line	:	20720 VENTURA BLVD
Second Line	:	SUITE 210
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364
Country	:	US
Telephone Number	:	818-754-4644
Fax Number	:	818-587-3353

Provider Business Practice Location Address
First Line	:	20720 VENTURA BLVD
Second Line	:	SUITE 210
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2306
Country	:	US
Telephone Number	:	818-754-4644
Fax Number	:	818-587-3353

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AMANDA BARNETT
Credential	:	LCSW
Telephone Number	:	818-754-4644

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	05/22/2015

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