MEDICARE: AMANDA S VAN ERDEN LICSW

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	LCSW106750	CA
2	1041C0700X	Clinical Social Worker	LW60958332	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770812687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA S VAN ERDEN LICSW

Provider Business Mailing Address
First Line	:	1092 WRIGHT PLACE
Second Line	:	CORNERSTONE CONFERENCE CENTER 2ND FLOOR
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	929-468-2465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 WRIGHT PLACE
Second Line	:	CORNERSTONE CONFERENCE CENTER 2ND FLOOR
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	929-468-2465
Fax Number	:

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

Provider Enumeration Date	:	12/24/2009
Last Update Date	:	06/30/2025

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