Healthcare Provider Details

I. General information

NPI: 1215654793
Provider Name (Legal Business Name): AMANDA KAMINNIK MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9754 PARKVIEW AVE
BOCA RATON FL
33428-2917
US

IV. Provider business mailing address

9754 PARKVIEW AVE
BOCA RATON FL
33428-2917
US

V. Phone/Fax

Practice location:
  • Phone: 561-789-6639
  • Fax:
Mailing address:
  • Phone: 561-789-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: