Provider Demographics
NPI:1891565727
Name:MAGNOTTA, AMANDA JANE (LMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:MAGNOTTA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 KENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4032
Mailing Address - Country:US
Mailing Address - Phone:845-803-7206
Mailing Address - Fax:
Practice Address - Street 1:27 KENTWOOD DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4032
Practice Address - Country:US
Practice Address - Phone:845-803-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
NY109015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool