Provider Demographics
NPI:1184054736
Name:WAYNE, AMANDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROUTE168, SUITED2
Mailing Address - Street 2:WASHINGTON PROFESSIONAL CAMPUS
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1125
Mailing Address - Country:US
Mailing Address - Phone:856-352-0061
Mailing Address - Fax:
Practice Address - Street 1:6 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1319
Practice Address - Country:US
Practice Address - Phone:908-782-7905
Practice Address - Fax:908-782-5934
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045054001041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087866Medicaid