Healthcare Provider Details

I. General information

NPI: 1124529698
Provider Name (Legal Business Name): AMANDA FITTS LSX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

IV. Provider business mailing address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-2136
  • Fax: 800-638-3455
Mailing address:
  • Phone: 888-322-2136
  • Fax: 800-638-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSX16984
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: