Healthcare Provider Details

I. General information

NPI: 1982094264
Provider Name (Legal Business Name): AMANDA SHIFREEN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PROSPECT AVE
HARTFORD CT
06105-4230
US

IV. Provider business mailing address

998 FARMINGTON AVE STE 207
WEST HARTFORD CT
06107-2184
US

V. Phone/Fax

Practice location:
  • Phone: 860-559-9231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005845
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: