Provider Demographics
NPI:1376509752
Name:MULLEN, AMANDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3109
Mailing Address - Country:US
Mailing Address - Phone:413-585-9991
Mailing Address - Fax:413-585-9902
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3109
Practice Address - Country:US
Practice Address - Phone:413-585-9991
Practice Address - Fax:413-585-9902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
M21719Medicare ID - Type Unspecified