Healthcare Provider Details

I. General information

NPI: 1376477406
Provider Name (Legal Business Name): AMANDA MCDONNELL MA, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S IRVING AVE
SCRANTON PA
18505-2497
US

IV. Provider business mailing address

415 BIDEN ST
SCRANTON PA
18503-1803
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-3685
  • Fax:
Mailing address:
  • Phone: 800-226-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020489
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: