Provider Demographics
NPI:1083169676
Name:LETARD, AMANDA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEAN
Last Name:LETARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 POST RD E
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5643
Mailing Address - Country:US
Mailing Address - Phone:203-220-6486
Mailing Address - Fax:203-220-6486
Practice Address - Street 1:1720 POST RD E
Practice Address - Street 2:SUITE 223
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5643
Practice Address - Country:US
Practice Address - Phone:203-220-6486
Practice Address - Fax:203-220-6486
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist