Individual
AMANDA K MADRID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12440 E FIRESTONE BLVD, SUITE 3020, NORWALK, CA 90650-9331
(562) 864-7821
Mailing address
252 16TH PL APT C, COSTA MESA, CA 92627-9410
(319) 360-5995
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
81455
CA
1041C0700X
Clinical Social Worker
Primary
101502
CA
167G00000X
Licensed Psychiatric Technician
37965
CA
Other
Enumeration date
03/17/2015
Last updated
06/14/2021
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