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NPI Code Detail

MEDICARE: AMANDA NICOLE REAM LCSW, MSW, MED

MEDICARE: AMANDA NICOLE REAM LCSW, MSW, MED
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
11041C0700XClinical Social WorkerCW018658PA

General Provider Information

NPI Number : 1689025421
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NICOLE REAM LCSW, MSW, MED
Provider Business Mailing Address
First Line : 2310 E SUSQUEHANNA AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-2524
Country : US
Telephone Number : 267-994-7640
Fax Number :
Provider Business Practice Location Address
First Line : 440 E GIRARD AVE
Second Line : THRESHOLD WELLNESS
City : PHILADELPHIA
State : PA
Zip : 19125-3326
Country : US
Telephone Number : 267-994-7640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2016
Last Update Date : 06/22/2016

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