Provider Demographics
NPI:1326859513
Name:GREGORY, AMANDA K
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2813
Mailing Address - Country:US
Mailing Address - Phone:814-319-3389
Mailing Address - Fax:
Practice Address - Street 1:4012 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORN
Practice Address - State:PA
Practice Address - Zip Code:16230
Practice Address - Country:US
Practice Address - Phone:814-275-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142395104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker