MEDICARE: AMANDA MARIE SPAULDING MHC

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	P124644	NY

General Provider Information

NPI Number	:	1932919917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE SPAULDING MHC

Provider Business Mailing Address
First Line	:	375 BAY RD STE 100
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3004
Country	:	US
Telephone Number	:	518-521-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 BAY RD STE 100
Second Line	:	SUITE 100
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3004
Country	:	US
Telephone Number	:	518-521-4844
Fax Number	:

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

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	01/10/2025

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