Provider Demographics
NPI:1366878241
Name:AYERS, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:AYERS
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 1:75 WOODFORD AVENUE EXT APT 1
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2561
Mailing Address - Country:US
Mailing Address - Phone:860-921-3417
Mailing Address - Fax:
Practice Address - Street 1:75 WOODFORD AVENUE EXT APT 1
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2561
Practice Address - Country:US
Practice Address - Phone:860-410-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098561041C0700X
CT1644104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUNITED BEHAVIORAL HEALTH-UNITED HEALTHCARE/WELLMORE GRP/FACILITY
CTD339209OtherVALUE OPTIONS
CTNOT ELIGIBLEOtherMHN-TRICARE NORTH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherCAQH
CT060669107OtherANTHEM BCBS OF CT-WELLMORE, INC GROUP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH-CONNECTICARE/WELLMORE-GRP/FACILITY
CTNOT ELIGIBLEOtherMHN MANAGE HEALTH NETWORK
CTPENDINGMedicaid
CT060669107OtherHEALTHYCT- WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH/OXFORD/LIBERTY-WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH