MEDICARE: MISS AMANDA JONES STANFORTH 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	P010538	NC

General Provider Information

NPI Number	:	1457703209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA JONES STANFORTH LCSW

Provider Business Mailing Address
First Line	:	2329 GLASCOCK ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1601
Country	:	US
Telephone Number	:	252-217-9335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WAKE FOREST RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1354
Country	:	US
Telephone Number	:	919-324-0906
Fax Number	:	984-500-1860

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	11/01/2023

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