Provider Demographics
NPI:1982978565
Name:SWARTZLENDER, AMANDA WOODMAN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:WOODMAN
Last Name:SWARTZLENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 MCKENZIE OAK LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6861
Mailing Address - Country:US
Mailing Address - Phone:808-258-8089
Mailing Address - Fax:904-940-6982
Practice Address - Street 1:631 MARKET ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8892
Practice Address - Country:US
Practice Address - Phone:808-258-8089
Practice Address - Fax:904-687-0551
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9369101YM0800X
FLMH12109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health