MEDICARE: AMANDA ETENGOFF LMFT

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	106H00000X	Marriage & Family Therapist	MT3493	FL

General Provider Information

NPI Number	:	1346630985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ETENGOFF LMFT

Provider Business Mailing Address
First Line	:	5347 NW 122ND DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3630
Country	:	US
Telephone Number	:	954-552-8997
Fax Number	:

Provider Business Practice Location Address
First Line	:	5347 NW 122ND DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3630
Country	:	US
Telephone Number	:	954-552-8997
Fax Number	:

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

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	03/25/2024

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Directions to “ AMANDA ETENGOFF LMFT” Practice Location

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