Healthcare Provider Details

I. General information

NPI: 1487518387
Provider Name (Legal Business Name): AMANDA EMILY NEGRON MED, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE 92
HAZLET NJ
07730-1669
US

IV. Provider business mailing address

22 VICTORIAN DR
OLD BRIDGE NJ
08857-3048
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-3848
  • Fax:
Mailing address:
  • Phone: 973-997-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01143300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: