MEDICARE: AMANDA JELDEN 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	9625	CT

General Provider Information

NPI Number	:	1801338488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JELDEN LCSW

Provider Business Mailing Address
First Line	:	5 LORENZ INDUSTRIAL PKWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1946
Country	:	US
Telephone Number	:	860-892-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 LORENZ INDUSTRIAL PKWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1946
Country	:	US
Telephone Number	:	860-892-7042
Fax Number	:

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

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	01/07/2022

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