Individual
AMANDA WAGENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1225 W 190TH ST STE 255, GARDENA, CA 90248-4342
(310) 748-3772
Mailing address
1225 W 190TH ST STE 255, GARDENA, CA 90248-4342
(310) 748-3772
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/28/2022
Last updated
11/07/2025
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