MEDICARE: MS. AMANDA JEAN PARKER 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	85682	CA

General Provider Information

NPI Number	:	1477029866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA JEAN PARKER LCSW

Provider Business Mailing Address
First Line	:	2861 MALCOLM AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4211
Country	:	US
Telephone Number	:	310-755-8375
Fax Number	:

Provider Business Practice Location Address
First Line	:	6368 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6320
Country	:	US
Telephone Number	:	323-469-5555
Fax Number	:

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

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/23/2018

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