Provider Demographics
NPI:1487654372
Name:AMATORE, BRIDGET (PHD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:AMATORE
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 1:2373 BROADWAY
Mailing Address - Street 2:APARTMENT 711
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2373 BROADWAY
Practice Address - Street 2:APARTMENT 711
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2800
Practice Address - Country:US
Practice Address - Phone:212-721-1066
Practice Address - Fax:212-721-8226
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009101-1103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical