MEDICARE: AMANDA WELBY 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	1041C0700X	Clinical Social Worker	CW026103	PA
2	1041C0700X	Clinical Social Worker	LCSW136045	CA

General Provider Information

NPI Number	:	1275492886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WELBY LCSW

Provider Business Mailing Address
First Line	:	2219 MAIN ST # 262
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 MAIN ST # 262
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2217
Country	:	US
Telephone Number	:	323-412-9090
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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