Provider Demographics
NPI:1275163107
Name:DEINSTADT, AMANDA GRACE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:DEINSTADT
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 1:11 DOANE AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4025
Mailing Address - Country:US
Mailing Address - Phone:978-766-7323
Mailing Address - Fax:
Practice Address - Street 1:11 DOANE AVE
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4025
Practice Address - Country:US
Practice Address - Phone:978-766-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst