Provider Demographics
NPI:1518603109
Name:PETTINELLI, AMANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PETTINELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FERGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2602
Mailing Address - Country:US
Mailing Address - Phone:772-485-9857
Mailing Address - Fax:
Practice Address - Street 1:1626 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6305
Practice Address - Country:US
Practice Address - Phone:215-543-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty