Healthcare Provider Details

I. General information

NPI: 1780148098
Provider Name (Legal Business Name): AMANDA MUISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GAYTHORNE RD STE 1U
METHUEN MA
01844-2035
US

IV. Provider business mailing address

147 RANGEWAY RD UNIT 2306
NORTH BILLERICA MA
01862-2040
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-0194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: