MEDICARE: KELLY F AMATO 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	44SC05638600	NJ

General Provider Information

NPI Number	:	1447885660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY F AMATO LCSW

Provider Business Mailing Address
First Line	:	14 N PEARL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-575-0818

Provider Business Practice Location Address
First Line	:	14 N PEARL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-575-0818

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	07/06/2022

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