Basic Information
| Provider Information | |||||||||
| NPI: | 1831821651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENWELL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 N EL CAMINO REAL STE 211 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773814115 | ||||||||
| FaxNumber: | 8589011461 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 N EL CAMINO REAL STE 211 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773814115 | ||||||||
| FaxNumber: | 8589011461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 101100 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.