Healthcare Provider Details

I. General information

NPI: 1225461940
Provider Name (Legal Business Name): AMANDA CHRISTINE PASCIUCCO PHD, LMFT, AASECTCST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/03/2023
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 FARMINGTON AVE STE 2C
WEST HARTFORD CT
06119-1672
US

IV. Provider business mailing address

801 FARMINGTON AVE STE 2C
WEST HARTFORD CT
06119-1672
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-9600
  • Fax:
Mailing address:
  • Phone: 203-733-9600
  • Fax: 855-597-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001556
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: