=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831986512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANECER COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 MAIN ST UNIT 6
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-3669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-308-3958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 MAIN ST UNIT 6
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-3669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-308-3958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. AMELIA K ORTEGA
-----------------------------------------------------
Credential | DSW, LCSW, SIFI
-----------------------------------------------------
Telephone | 617-308-3958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------