Healthcare Provider Details

I. General information

NPI: 1437079399
Provider Name (Legal Business Name): MRS. AMANDA MARIE WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE ST
BRISTOL CT
06010-6374
US

IV. Provider business mailing address

207 GEORGE ST APT 534
MIDDLETOWN CT
06457-6703
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12158
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: