Provider Demographics
NPI:1437219011
Name:O'BRIEN MILLEISEN, AMANDA ROSE (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:O'BRIEN MILLEISEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:LEGAL DEPARTMENT
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:1 PROSPECT ST STE 4-7
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4404
Practice Address - Country:US
Practice Address - Phone:201-447-2242
Practice Address - Fax:201-447-4377
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100454100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical