Provider Demographics
NPI:1194577296
Name:LEJMAN, AMANDA NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:LEJMAN
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 1:830 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7150
Mailing Address - Country:US
Mailing Address - Phone:516-240-3083
Mailing Address - Fax:
Practice Address - Street 1:755 MONTAUK HWY STE 3
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1801
Practice Address - Country:US
Practice Address - Phone:631-602-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121869-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker