Provider Demographics
NPI:1770812687
Name:VAN ERDEN, AMANDA S (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:VAN ERDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 WRIGHT PLACE
Mailing Address - Street 2:CORNERSTONE CONFERENCE CENTER 2ND FLOOR
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:929-468-2465
Mailing Address - Fax:
Practice Address - Street 1:1902 WRIGHT PLACE
Practice Address - Street 2:CORNERSTONE CONFERENCE CENTER 2ND FLOOR
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:929-468-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1067501041C0700X
WALW609583321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770812687Medicaid
WA2139329Medicaid