Individual
AMANDA MARISCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MPH
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-1020
Mailing address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
CT
1041C0700X
Clinical Social Worker
Primary
010181
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0040404564
—
CT
Enumeration date
07/11/2016
Last updated
04/12/2024
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