Basic Information
| Provider Information | |||||||||
| NPI: | 1831366624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 S MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460522784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654827421 | ||||||||
| FaxNumber: | 7654827462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 S MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460522784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654827421 | ||||||||
| FaxNumber: | 7654827462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34005458A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.