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General NPI Number Information
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NPI Number | 1942789102
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Entity Type | Individual
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Provider Name | AMANDA LOUISE JANKOLI
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 6 EDGERLY PL FL 3
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City | BOSTON
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State | MA
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Zip | 02116-5327
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Country | US
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Telephone | 617-286-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 249 3RD ST
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1392
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Country | US
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Telephone | 401-749-2380
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW2410356
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License Number State | MA
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