MEDICARE: MRS. AMANDA MARIE DAVID LMHC

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	101YM0800X	Mental Health Counselor	MH 10805	FL

General Provider Information

NPI Number	:	1770992414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA MARIE DAVID LMHC

Provider Business Mailing Address
First Line	:	6923 CONSOLATA ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7553
Country	:	US
Telephone Number	:	850-525-3881
Fax Number	:	561-325-8081

Provider Business Practice Location Address
First Line	:	6919 SW 18TH ST STE 200/227
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7010
Country	:	US
Telephone Number	:	561-325-8031
Fax Number	:	561-325-8081

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	04/18/2023

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