Provider Demographics
NPI:1114702602
Name:BREESE, AMANDA C
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:C
Last Name:BREESE
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 1:286 SANNITA DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3616
Mailing Address - Country:US
Mailing Address - Phone:607-793-3962
Mailing Address - Fax:
Practice Address - Street 1:286 SANNITA DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3616
Practice Address - Country:US
Practice Address - Phone:607-793-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool