MEDICARE: AMANDA ALLEN LMHC, LPC

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
1	101YM0800X	Mental Health Counselor	006032	NY

General Provider Information

NPI Number	:	1205340874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ALLEN LMHC, LPC

Provider Business Mailing Address
First Line	:	110 1ST ST APT 34E
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-8999
Country	:	US
Telephone Number	:	732-236-3846
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 1ST ST APT 34E
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-8999
Country	:	US
Telephone Number	:	732-236-3846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2017
Last Update Date	:	11/19/2017

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