Healthcare Provider Details

I. General information

NPI: 1962824714
Provider Name (Legal Business Name): MRS. AMANDA PEERCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 12/20/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 CYPRESS GLEN CIR
KISSIMMEE FL
34741-7560
US

IV. Provider business mailing address

4694 BERINGER DR
LAFAYETTE IN
47909-6985
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-2103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW9778
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101YM0800X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: