Healthcare Provider Details

I. General information

NPI: 1013564582
Provider Name (Legal Business Name): AMANDA SCHELL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CHRISTY DR
BROCKTON MA
02301-1839
US

IV. Provider business mailing address

1191 BROADWAY
HANOVER MA
02339-2503
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-4611
  • Fax:
Mailing address:
  • Phone: 781-733-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10000488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: