Individual
AMANDA ROSE KETTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
10819 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-1034
(718) 845-2620
Mailing address
2070 OCEAN AVE, RONKONKOMA, NY 11779-6536
(631) 624-1533
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
110024
NY
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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