Provider Demographics
NPI:1104331156
Name:AMANDA T PAUL, LCSW, MT-BC
Entity type:Organization
Organization Name:AMANDA T PAUL, LCSW, MT-BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:THOMASON
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MT-BC
Authorized Official - Phone:502-640-3940
Mailing Address - Street 1:4523 GREYMONT DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3588
Mailing Address - Country:US
Mailing Address - Phone:502-640-3940
Mailing Address - Fax:
Practice Address - Street 1:4523 GREYMONT DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3588
Practice Address - Country:US
Practice Address - Phone:502-640-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty