Provider Demographics
NPI:1346876414
Name:LUPFER, AMANDA L (LPC, ATR-BC, CLAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:LUPFER
Suffix:
Gender:F
Credentials:LPC, ATR-BC, CLAT
Other - Prefix:
Other - First Name:EDGAR
Other - Middle Name:D
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, ATR-BC, CLAT
Mailing Address - Street 1:331 WETHERSFIELD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1438
Mailing Address - Country:US
Mailing Address - Phone:860-236-4511
Mailing Address - Fax:860-231-8849
Practice Address - Street 1:331 WETHERSFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1438
Practice Address - Country:US
Practice Address - Phone:860-236-4511
Practice Address - Fax:860-231-8849
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT19-560221700000X
CT4979101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist