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General NPI Number Information
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NPI Number | 1396509006
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Entity Type | Individual
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Provider Name | AMANDA ROSE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 47 TOWN ST
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City | NORWICH
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State | CT
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Zip | 06360-2323
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Country | US
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Telephone | 860-822-2857
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Fax |
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Provider Business Mailing Address
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Address Line | 235 MAIN ST APT 3
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3726
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Country | US
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Telephone | 860-652-5440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3682
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT00311
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License Number State | RI
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