Provider Demographics
NPI:1720730971
Name:PERPICH BROWN, AMANDA JEAN (LCSW, LMSW, MSW MACJ)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN
Last Name:PERPICH BROWN
Suffix:
Gender:F
Credentials:LCSW, LMSW, MSW MACJ
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LMSW, MSW MACJ
Mailing Address - Street 1:PO BOX 1693
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-1693
Mailing Address - Country:US
Mailing Address - Phone:602-717-7316
Mailing Address - Fax:
Practice Address - Street 1:405 13TH ST SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9058
Practice Address - Country:US
Practice Address - Phone:602-717-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13092104100000X
IDLCSW-432391041C0700X
ORA129951041C0700X
ORL110641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker