Provider Demographics
NPI:1962753384
Name:TAYE, AMNEH (LCSW)
Entity type:Individual
Prefix:
First Name:AMNEH
Middle Name:
Last Name:TAYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 CASTILE CT APT B
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6067
Mailing Address - Country:US
Mailing Address - Phone:213-640-0066
Mailing Address - Fax:
Practice Address - Street 1:10001 CASTILE CT APT B
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-6067
Practice Address - Country:US
Practice Address - Phone:213-640-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10682OtherSOCIAL WORK BOARD