Individual
MRS. AMANDA B FETSKO
Active
Individual
MRS. AMANDA B FETSKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LCSW, CPRP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
PA
104100000X
Social Worker
SW130206
PA
1041C0700X
Clinical Social Worker
Primary
CW018512
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440027
—
PA
01
—
12482662
CAQH
PA
01
—
328834A336347
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
03/01/2007
Last updated
10/05/2022
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