Provider Demographics
NPI:1396332755
Name:ANANIAN, AMANDA CASSANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CASSANDRA
Last Name:ANANIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CASSANDRA
Other - Last Name:FRUMENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21281 DARNEL AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9579
Mailing Address - Country:US
Mailing Address - Phone:541-299-2981
Mailing Address - Fax:
Practice Address - Street 1:21281 DARNEL AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9579
Practice Address - Country:US
Practice Address - Phone:541-801-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL106891041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical