MEDICARE: AMY MARIE DENNIS 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		CA

General Provider Information

NPI Number	:	1578063632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE DENNIS LCSW

Provider Business Mailing Address
First Line	:	17216 SEVEN SPRINGS WAY
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-9428
Country	:	US
Telephone Number	:	951-288-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4244 RIVERWALK PKWY
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-8509
Country	:	US
Telephone Number	:	951-288-0567
Fax Number	:

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

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	03/17/2018

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