Provider Demographics
NPI:1326308156
Name:KITTO, AMANDA MARY (MS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARY
Last Name:KITTO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MARY
Other - Last Name:FOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3821 34TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1330
Mailing Address - Country:US
Mailing Address - Phone:727-242-1775
Mailing Address - Fax:
Practice Address - Street 1:1001 16TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2231
Practice Address - Country:US
Practice Address - Phone:727-242-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor