Healthcare Provider Details

I. General information

NPI: 1003231762
Provider Name (Legal Business Name): AMANDA HADDAD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E PALMDALE BLVD STE K
PALMDALE CA
93550-1326
US

IV. Provider business mailing address

2231 E PALMDALE BLVD STE K
PALMDALE CA
93550-1326
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone: 909-599-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT99423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: