MEDICARE: AMANDA L FONTAINE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT00098	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1023290	OTHER	RI	NEIGHBORHOOD HEALTH OF RI
3	27655-1	OTHER	RI	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	411932	OTHER	RI	BLUE CHIP

General Provider Information

NPI Number	:	1679503924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L FONTAINE LMFT

Provider Business Mailing Address
First Line	:	23 NORTH RD STE A25
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-487-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH RD STE A25
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-487-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/22/2020

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Directions to “ AMANDA L FONTAINE LMFT” Practice Location

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