Provider Demographics
NPI:1215184007
Name:CANNAMELA, AMANDA L (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:CANNAMELA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0147
Mailing Address - Country:US
Mailing Address - Phone:802-399-9337
Mailing Address - Fax:
Practice Address - Street 1:310 HANON DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8857
Practice Address - Country:US
Practice Address - Phone:802-399-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000752101YM0800X
VT151.0124773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015416Medicaid
3010878OtherMVP
VT600529540OtherMAGELLAN - BCBS
VT00071241OtherBCBS- UNMANAGED