Provider Demographics
NPI:1437422664
Name:DIEHL LELYVELD, AMANDA L (MS, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:DIEHL LELYVELD
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LEANNE
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4530
Mailing Address - Country:US
Mailing Address - Phone:845-702-4341
Mailing Address - Fax:
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4296
Practice Address - Country:US
Practice Address - Phone:203-931-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional