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General NPI Number Information
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NPI Number | 1811605363
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Entity Type | Individual
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Provider Name | AMANDA COURTNEY ROSE PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 3460 COUNTY LINE RD
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City | SKANEATELES
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State | NY
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Zip | 13152-0017
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Country | US
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Telephone | 315-217-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 SAGE MEADOWS DR
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City | MARCELLUS
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State | NY
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Zip | 13108-7851
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019589
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License Number State | NY
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