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General NPI Number Information
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NPI Number | 1619458130
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Entity Type | Individual
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Provider Name | AMANDA MAUREEN MCINERNEY LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 650 HALLOCK AVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1256
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Country | US
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Telephone | 631-403-3318
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Fax | 631-509-4824
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Provider Business Mailing Address
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Address Line | 142 SUNSET AVE
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City | SELDEN
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State | NY
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Zip | 11784-2924
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Country | US
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Telephone | 631-338-9795
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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