Provider Demographics
NPI:1275142366
Name:MENTZER, AMANDA (BS MA MA MPHIL PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MENTZER
Suffix:
Gender:F
Credentials:BS MA MA MPHIL PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20801 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1333
Mailing Address - Country:US
Mailing Address - Phone:717-554-4053
Mailing Address - Fax:
Practice Address - Street 1:107 W 82ND ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5511
Practice Address - Country:US
Practice Address - Phone:646-450-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5749103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst