Provider Demographics
NPI:1053729228
Name:ISTVAN, AMANDA LEE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:ISTVAN
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:ISTVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, CSW
Mailing Address - Street 1:1351 NEWTOWN PIKE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1277
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:1351 NEWTOWN PIKE BLDG 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1277
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid