Provider Demographics
NPI:1104541564
Name:BOCCARDI, AMANDA ROSE (LMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:BOCCARDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MANSFIELD ST APT A
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1710
Mailing Address - Country:US
Mailing Address - Phone:475-228-6656
Mailing Address - Fax:
Practice Address - Street 1:33 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3457
Practice Address - Country:US
Practice Address - Phone:203-740-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker