Provider Demographics
NPI:1164607719
Name:WEIDEL, AMANDA EILEEN (PCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:WEIDEL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 DRIGGS AVE
Mailing Address - Street 2:4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4624
Mailing Address - Country:US
Mailing Address - Phone:937-219-3446
Mailing Address - Fax:
Practice Address - Street 1:333 PARK AVE S
Practice Address - Street 2:3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2906
Practice Address - Country:US
Practice Address - Phone:212-388-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health