Provider Demographics
NPI:1487888632
Name:POOLE, AMANDA GRIER (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GRIER
Last Name:POOLE
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 1:4 LAFAYETTE CT APT 6D
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5304
Mailing Address - Country:US
Mailing Address - Phone:917-302-5455
Mailing Address - Fax:
Practice Address - Street 1:2 BENEDICT PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5358
Practice Address - Country:US
Practice Address - Phone:917-302-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006084OtherLCSW