Healthcare Provider Details

I. General information

NPI: 1679092746
Provider Name (Legal Business Name): MISS AMANDA ELIZABETH GERRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 CAPITOL TRL STE 250
NEWARK DE
19711-7231
US

IV. Provider business mailing address

2644 CAPITOL TRL STE 250
NEWARK DE
19711-7231
US

V. Phone/Fax

Practice location:
  • Phone: 302-683-1055
  • Fax:
Mailing address:
  • Phone: 302-683-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0000306
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: