Individual
AMANDA CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7033 E TUDOR RD, ANCHORAGE, AK 99507-1262
(907) 729-8961
Mailing address
15 HORSEBLOCK PL, FARMINGVILLE, NY 11738-1204
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116000464
—
NY
Enumeration date
09/12/2017
Last updated
11/06/2023
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