Healthcare Provider Details

I. General information

NPI: 1295630515
Provider Name (Legal Business Name): AMANDA NICOLE INNAMORATO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 UNION AVE
BRIDGEWATER NJ
08807-3064
US

IV. Provider business mailing address

37 W FRANKLIN AVE
PEQUANNOCK NJ
07440-1520
US

V. Phone/Fax

Practice location:
  • Phone: 908-356-5955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00987100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: