Provider Demographics
NPI:1437211950
Name:MINER FLETCHER, AMY DIANE (LMHC CEID)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIANE
Last Name:MINER FLETCHER
Suffix:
Gender:F
Credentials:LMHC CEID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAURA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-455-2871
Mailing Address - Fax:
Practice Address - Street 1:1115 W CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-559-0473
Practice Address - Fax:508-584-2227
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154D101Y00000X
MA4692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health