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NPI Code Detail

MEDICARE: AMANDA R WEATHERMAN MSW, LCSW

MEDICARE: AMANDA R WEATHERMAN MSW, 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
11041C0700XClinical Social WorkerSW25317FL
2104100000XSocial Worker

Other Identifiers

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

General Provider Information

NPI Number : 1770843021
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA R WEATHERMAN MSW, LCSW
Provider Business Mailing Address
First Line : 2618 TOLMAN AVE SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-7220
Country : US
Telephone Number : 772-579-0721
Fax Number :
Provider Business Practice Location Address
First Line : 130 S INDIAN RIVER DR STE 202
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4353
Country : US
Telephone Number : 772-773-0229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 06/14/2026

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