Healthcare Provider Details

I. General information

NPI: 1669824553
Provider Name (Legal Business Name): AMANDA KONIEWICZ PSY.D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063-2561
US

IV. Provider business mailing address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 484-363-9280
  • Fax:
Mailing address:
  • Phone: 484-363-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012293
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPC012293
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: