Healthcare Provider Details

I. General information

NPI: 1972832293
Provider Name (Legal Business Name): AMANDA G. TAYLOR LMFT, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WAYLAND AVE
PROVIDENCE RI
02906-4314
US

IV. Provider business mailing address

99 WAYLAND AVE
PROVIDENCE RI
02906-4314
US

V. Phone/Fax

Practice location:
  • Phone: 401-660-8821
  • Fax:
Mailing address:
  • Phone: 401-660-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT00202
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: