Provider Demographics
NPI:1083036958
Name:WELLS, AMANDA (LMHC #9708)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMHC #9708
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC #9708
Mailing Address - Street 1:33 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4605
Mailing Address - Country:US
Mailing Address - Phone:617-980-1093
Mailing Address - Fax:
Practice Address - Street 1:30 DANIELS ST APT 407
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4218
Practice Address - Country:US
Practice Address - Phone:617-980-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9708101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health