Provider Demographics
NPI:1811470891
Name:JURIST, AMANDA DENHAM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DENHAM
Last Name:JURIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:DUVON
Other - Last Name:DENHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-0003
Mailing Address - Country:US
Mailing Address - Phone:310-228-7360
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5002
Practice Address - Country:US
Practice Address - Phone:424-259-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA758971041C0700X
NY0864321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical