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NPI Code Detail

MEDICARE: DR. AMANDA STACEY BRONSON PSY.D.

MEDICARE: DR. AMANDA STACEY BRONSON PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1043591167
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA STACEY BRONSON PSY.D.
Provider Business Mailing Address
First Line : 40 SHATTUCK RD STE 250
Second Line :
City : ANDOVER
State : MA
Zip : 01810-2492
Country : US
Telephone Number : 978-222-3121
Fax Number :
Provider Business Practice Location Address
First Line : 40 SHATTUCK RD STE 250
Second Line :
City : ANDOVER
State : MA
Zip : 01810-2492
Country : US
Telephone Number : 978-222-3121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 12/05/2024

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