Healthcare Provider Details

I. General information

NPI: 1316803240
Provider Name (Legal Business Name): AMPLIFY MENTAL HEATH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 F CAPELLA ST
BEVERLY NJ
08010-1756
US

IV. Provider business mailing address

25 F CAPELLA ST
BEVERLY NJ
08010-1756
US

V. Phone/Fax

Practice location:
  • Phone: 267-444-5827
  • Fax:
Mailing address:
  • Phone: 215-259-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTORIA AMANDA POTENTE
Title or Position: OWNER
Credential: LCSW
Phone: 267-444-5827