Healthcare Provider Details

I. General information

NPI: 1346876414
Provider Name (Legal Business Name): AMANDA L LUPFER LPC, ATR-BC, CLAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EDGAR D SCOTT LPC, ATR-BC, CLAT

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WETHERSFIELD AVE STE 2
HARTFORD CT
06114-1438
US

IV. Provider business mailing address

331 WETHERSFIELD AVE STE 2
HARTFORD CT
06114-1438
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax: 860-231-8849
Mailing address:
  • Phone: 860-236-4511
  • Fax: 860-231-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4979
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number19-560
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: