MEDICARE: AMANDA MARIA LUGO LMSW

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	126362	NY

General Provider Information

NPI Number	:	1407718638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIA LUGO LMSW

Provider Business Mailing Address
First Line	:	620 W 171ST ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3108
Country	:	US
Telephone Number	:	845-548-8762
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 W 171ST ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3108
Country	:	US
Telephone Number	:	845-548-8762
Fax Number	:

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

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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Directions to “ AMANDA MARIA LUGO LMSW” Practice Location

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