Individual
MS. AMANNDA A WALWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8115 164TH ST, JAMAICA, NY 11432-1118
(718) 380-3000
(718) 380-9475
Mailing address
8115 164TH ST, JAMAICA, NY 11432-1118
(718) 380-3000
(718) 380-9475
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
093066
NY
1041C0700X
Clinical Social Worker
Primary
078869
NY
Other
Enumeration date
03/09/2012
Last updated
09/13/2021
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