=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861908618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA OSMAN LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2017
-----------------------------------------------------
Last Update Date | 12/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4245 CORPORAL KENNEDY ST 3E
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-533-6760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4245 CORPORAL KENNEDY ST 3E
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-533-6760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 007862
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------