Provider Demographics
NPI:1437752953
Name:BAUER, AMANDA MICHELE (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:BAUER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:MANZELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3987 14TH WAY NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5412
Mailing Address - Country:US
Mailing Address - Phone:516-315-9771
Mailing Address - Fax:
Practice Address - Street 1:3005 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5630
Practice Address - Country:US
Practice Address - Phone:516-315-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health