Healthcare Provider Details

I. General information

NPI: 1104624980
Provider Name (Legal Business Name): AMANDA TROOP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MAIN ST N
SOUTHBURY CT
06488-2200
US

IV. Provider business mailing address

6 RIVERSIDE DR APT 208
SHELTON CT
06484-8152
US

V. Phone/Fax

Practice location:
  • Phone: 203-518-5956
  • Fax: 203-490-4242
Mailing address:
  • Phone: 203-906-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8139
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: