MEDICARE: AMANDA LINEHAN MS, CAS, NCSP

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	103TS0200X	School Psychologist	2514460	NY
2	103TS0200X	School Psychologist	1460288	FL

General Provider Information

NPI Number	:	1649053737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LINEHAN MS, CAS, NCSP

Provider Business Mailing Address
First Line	:	11348 CANOPY LOOP
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-9675
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11348 CANOPY LOOP
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-9675
Country	:	US
Telephone Number	:	631-681-5388
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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