Provider Demographics
NPI:1073013611
Name:PROWITZ, AMANDA VICTORIA (NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:VICTORIA
Last Name:PROWITZ
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:VICTORIA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC
Mailing Address - Street 1:11 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1846
Mailing Address - Country:US
Mailing Address - Phone:302-898-2034
Mailing Address - Fax:
Practice Address - Street 1:262 CHAPMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5412
Practice Address - Country:US
Practice Address - Phone:302-292-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health