Provider Demographics
NPI:1033965504
Name:AMANO, KATHLEEN Y
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:Y
Last Name:AMANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-5144
Mailing Address - Country:US
Mailing Address - Phone:703-819-7433
Mailing Address - Fax:
Practice Address - Street 1:322 E ANTIETAM ST STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5736
Practice Address - Country:US
Practice Address - Phone:301-733-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor