Provider Demographics
NPI:1861570897
Name:ANTENUCCI, AMANDA CENZINA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CENZINA
Last Name:ANTENUCCI
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 SW BARBUR BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4018
Mailing Address - Country:US
Mailing Address - Phone:503-893-5628
Mailing Address - Fax:
Practice Address - Street 1:8414 SW BARBUR BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4018
Practice Address - Country:US
Practice Address - Phone:503-893-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614051941041C0700X
ORL64441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical