Provider Demographics
NPI:1982488433
Name:MORAN, AMANDA ANN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:MORAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TANGLEWOOD CT APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2513
Mailing Address - Country:US
Mailing Address - Phone:401-499-2792
Mailing Address - Fax:
Practice Address - Street 1:1 TEDDY CT
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2277
Practice Address - Country:US
Practice Address - Phone:401-684-0747
Practice Address - Fax:401-684-0050
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW029221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty